INTRODUCTION: Perioperative blood transfusion (PBT) has been shown to contribute to cancer progression and mortality. This study sought to determine the impact of PBT during radical cystectomy on cancer-specific survival (CSS) and overall survival (OS). MATERIALS AND METHODS: The Columbia University Urologic Oncology Database was reviewed for patients who underwent a RC from 1989 to 2010 (n = 638). PBT was defined as non-autologous packed red blood cells (PRBC) received during the same hospital stay as the radical cystectomy. Clinical and pathological variables were compared between the cohorts and survival analysis was performed with the Kaplan-Meier and Cox-regression methods. The primary outcomes were CSS and OS. RESULTS: Of 638 patients identified, 209 patients (32.8%) underwent PBT with an average of 2.21 Â± 1.66 units transfused PRBC. Mean age was 68.1 Â± 11.2 years; median follow up was 25.5 months (range 1-164 months). The number of units of PRBC transfused was inversely associated with OS (HR 1.12; p = 0.008) and CSS (HR 1.12; p = 0.049) on univariable analysis. Additionally, Kaplan-Meier analysis demonstrated a significant difference in OS (p = 0.0211) in patients who received more units of PRBC. However, on multivariable analysis, the number of units of PRBC transfused was not an independent predictor of outcome for CSS (p = 0.300) or OS (p = 0.246). CONCLUSIONS: Each additional unit of PRBC received during radical cystectomy is associated with a decrease in survival. However, after controlling for clinical and pathologic factors which predict survival, PBT does not have an independent affect upon CSS or OS.