Reduction of Allogenic Blood Transfusion in Locally Advanced Kidney Cancer

Inclusion Criteria: * Renal masses ≥ cT2 (by any conventional imaging). * N1 or M1 disease is allowed if they are deemed surgical candidates (including cytoreductive nephrectomy). * Male and female patients. * 18 and older. * Ejection fraction (EF) ≥ 45% by echocardiogram (ECHO). * Adequate organ function as defined by: * Hemoglobin ≥ 9 g/dL. Pre-operative allogenic blood transfusion is allowed. * Platelets ≥ 100.000/μl. * Albumin ≥ 2.5 g/dL. * Aspartate Aminotransferase (AST) and alanine transaminase (ALT) ≤ 75U/L or total bilirubin ≤ 2.0 mg/dL. * WBC within institutional normal limits. * PT within institutional normal limits. * INR \< 1.5 and PTT normal. * Consent and compliance with all aspects of the study protocol. Exclusion Criteria: * Male and female younger than 18 years old. * Non-surgical candidate * Unstable angina.