['In this multi-institutional study of patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, we sought to identify factors associated with perioperative transfusion requirement as well as the association between blood transfusion and perioperative and oncologic outcomes.', 'The surgical databases across six high-volume institutions were analyzed to identify patients who underwent pancreaticoduodenectomy for pancreatic adenocarcinoma from 2005 to 2010. For statistical analyses, patients were then stratified by transfusion volume according to whether they received 0, 1-2, or >2 units of packed red blood cells.', 'Among 697 patients identified, 42\xa0% required blood transfusion. Twenty-three percent received 1-2 units, and 19\xa0% received >2 units. Factors associated with an increased transfusion requirement included older age, heart disease, diabetes, longer operative time, higher blood loss, tumor size, and non-R0 margin status (all p\u2009<\u20090.05). The median disease-free survival (13.8 vs. 18.3 months, p\u2009=\u20090.02) and overall survival (14.0 vs. 21.0 months, p\u2009<\u20090.0001) durations of transfused patients were shorter than those of transfusion-free patients. Multivariate modeling identified intraoperative transfusion of >2 units (hazard ratio, 1.92, p\u2009=\u20090.009) and postoperative transfusions as independent factors associated with decreased disease-free survival.'] Is perioperative blood transfusion associated with decreased survival in patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma : a multi-institutional study?