Perioperative Fresh Red Blood Cell Transfusion May Negatively Affect Recipient Survival After Liver Transplantation. Issue 2 (February 2018)

• Record Type: Journal Article
• Authors: Han, Sangbin; Kwon, Ji Hye; Jung, Sun Hee; Seo, Ji Young; Jo, Yong Jun; Jang, Jin Sung; Yeon, Seung Min; Jung, Sin Ho; Ko, Justin Sangwook; Gwak, Mi Sook; Cho, Duck; Son, Hee Jeong; Kim, Gaab Soo
• Is Part Of: Annals of surgery. Volume 267:Issue 2(2018:Feb.)
• Publication Date: 2018-02
• Subjects: Blood component transfusion -- erythrocyte -- graft-versus-host disease -- immune tolerance -- immunization -- immunomodulation -- immunosuppression -- leukocytes -- living donors -- lymphocytes -- microchimerism -- surgical site infection -- transfusion reaction -- transplantation; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000002062
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: The aim of this study is to evaluate the association between fresh red blood cell (RBC) transfusion and recipient survival after liver transplantation. Background: Fresh RBC products contain many viable leukocytes. Allogeneic leukocytes are responsible for adverse transfusion reactions in the immunocompromised host. Methods: Among 343 liver transplant recipients who underwent perioperative RBC transfusion, 91 of 226 who did not receive fresh RBCs were matched with 91 of 117 who received fresh RBCs with 1:1 matching ratio using the propensity score based on the amount of transfused blood products and others. Survival analysis was performed using the Cox model. Results: All transfused 3230 RBCs were leukoreduced and irradiated. Before matching, recipients in fresh RBC group received 3 U (2–6 U) of fresh RBCs. After a median follow-up of 60 months, 60 of 343 recipients (17.5%) died. Survival probability at 1/2/5 years after transplantation was 94.7%/92.0%/85.8% for nonfresh RBC group and 82.9%/76.0%/72.0% for fresh RBC group [death hazard ratio (HR) = 2.37 (1.43–3.94), P = 0.001]. In multivariable analysis, fresh RBC transfusion was significantly associated with increased death risk [HR = 2.33 (1.35–4.01), P = 0.002]. After matching, recipients in fresh RBC group received 3 U (2–5 U) of fresh RBCs. After a median follow-up of 56 months, 35 of 182 recipients (19.2%) died. Survival probability at 1/2/5 years was 95.6%/93.2%/86.0% for nonfresh RBC group and 85.7%/78.0%/73.0% for fresh RBC group [HR = 2.23 (1.43–3.94), P = 0.028]. Multivariable analysis confirmed a significance of fresh RBC transfusion [HR = 3.20 (1.51–6.78), P = 0.002]. Conclusion: Our findings suggest a potential negative impact of fresh RBC transfusion on the survival of patients undergoing liver transplantation. Abstract : Supplemental Digital Content is available in the text