Effect of WBC reduction of transfused RBCs on postoperative infection rates in cardiac surgery

Abstract

No evidence has been found, analyzed by intention to treat, that use of WBC-reduced, BCD, or WCF RBCs reduces postoperative inpatient infection in patients undergoing cardiac bypass surgery.

Transfusion-transmissible infections and transfusion-related immunomodulation

“…Through all randomized controlled trials only in cardiac surgery the findings were conclusive for a deleterious TRIM effect of WBC-containing RBCs with a higher short-term (up to three month post transfusion) mortality rate [69], [70], [71]. Though, even in this setting, the reasons for the excess deaths attributed to WBC-containing ABTs remain elusive.…”

Allogeneic leukocytes in cardiac surgery: Good or bad?

“…Four cardiac surgery RCTs have been published [31][32][33][34] and 2 other cardiac surgery studies are available only as abstracts and contain limited data [35,36]. The primary methods and results are shown in the Table 1.…”

“…Subgroup analysis showed that the mortality rate was only higher in the patients that received >3 RBC units in the BCD-RBC group than in the filtered RBC group. Wallis et al [32] conducted a study using 3 types of blood products: filtered whole blood (stored <7 d before filtration), BCD-RBC, and plasma-reduced RBCs. Postoperative mortality at 3 months was 0.5%, 2.9%, and 2.5%, respectively (p=0.2), indicating no additional deleterious effect of the greater number of leukocytes in plasmareduced RBCs, as compared to BCD-RBCs [32].…”

“…Wallis et al [32] conducted a study using 3 types of blood products: filtered whole blood (stored <7 d before filtration), BCD-RBC, and plasma-reduced RBCs. Postoperative mortality at 3 months was 0.5%, 2.9%, and 2.5%, respectively (p=0.2), indicating no additional deleterious effect of the greater number of leukocytes in plasmareduced RBCs, as compared to BCD-RBCs [32]. van de Watering et al [31] observed that mortality due to multiple-organ-dysfunction-syndrome (MODS) was the major cause of excess death following standard BCD-RBC transfusion.…”

“…It was reported that the number of units transfused not the soluble mediators leukocytes release during storage [31] or the leukocyte load per transfusion [32] is associated with poor outcome [31,33], suggesting that patients in poor clinical condition that undergo cardiac surgery and require multiple RBC transfusions are more susceptible to TRIM than other patients. We analyzed in detail the causes of death in 2 cardiac surgery RCTs [31,33] and observed that the rate of excessive death due to a combination of infection and MODS among the patients that received standard buffy coat-poor RBCs was higher than that among the patients that received leukodepleted FF-RBCs (OR 2.92; 95% CI 1.22-6.97; p=0.02).…”