Leukocyte-depletion of blood components does not significantly reduce the risk of infectious complications

Abstract

Allogeneic blood transfusions are claimed to be an independent risk factor for postoperative infections in open colorectal surgery due to immunomodulation. Leukocyte-depletion of erythrocyte suspensions has been shown in some open randomized studies to reduce the rate of postoperative infection to levels observed in nontransfused patients. Using a double-blinded, randomized design, we studied the postoperative infection rate in patients undergoing open colorectal surgery transfused with either leukocyte-depleted erythrocyte suspensions (LD-SAGM) or non-leukocyte-depleted erythrocyte suspensions (SAGM). Unselected patients (n 279) were allocated to receive LD-SAGM (n 139) or SAGM (n 140) if transfusion was indicated. Forty-five percent were transfused, yielding 48 patients in the LD-SAGM group and 64 in the SAGM group. Thirteen patients were excluded because they received one type of transfusion in spite of randomization to the other type. No significant differences in the rates of postoperative infections (P=0.5250) or postoperative complications (P=0.1779) were seen between the two transfused groups. Infection rates were 45% and 38% in the transfused groups and 21% and 23% in the nontransfused groups. No significant difference between the transfused groups was seen on any single infectious event, mortality rate, or duration of hospitalization. Leukocyte-depletion of erythrocyte suspensions transfused to patients undergoing open colorectal surgery does not reduce postoperative infection rates.

Leukodepleted blood components do not remove the potential for long-term transfusion-associated microchimerism in Australian major trauma patients

“…3 However, it has been noted that a leukodepleted RBC unit can contain up to one million donor leukocytes and still be within specification under the Council of Europe guidelines and clinical studies suggest that RBC transfusion is still associated with undesirable transfusion outcomes. 4,5 One such undesirable outcome is termed microchimerism, which is the co-existence of small numbers of genetically disparate cell populations within a single host. 6 Usually transfused donor cells are recognized by the recipient immune system and are removed within a few days of transfusion.…”

Allogeneic leukocytes in cardiac surgery: Good or bad?

“…In total, 13 RCTs on leukodepleted blood transfusions in different clinical settings evaluated postoperative infections as a primary or secondary endpoint [31][32][33][34][35][36][40][41][42][43][44][45][46]. These studies included singleand multicenter designs, clinical diagnosis, methods for documenting and reporting infections, and the proportion of transfused patients (range: 14%-95%).…”

“…These studies included singleand multicenter designs, clinical diagnosis, methods for documenting and reporting infections, and the proportion of transfused patients (range: 14%-95%). Among them, 5 included patients undergoing colorectal or gastrointestinal surgery [40][41][42][43][44], 1 was performed with patients undergoing aortic aneurysm repair or resection of gastrointestinal malignancy [45], and 1 included trauma patients [46]. The postoperative infection results in these RCTs, which were conducted with different patient populations using different study designs, are inconsistent.…”

Effects of Transfusion with Red Cells Filtered to Remove Leucocytes: Randomised Controlled Trial in Patients Undergoing Major Surgery

“…The recurrence of cancer was explored in only one study in patients with colorectal cancer, in which there was no advantage of removing leucocytes from transfusions. 11 Five prospective randomised studies investigated the incidence of postoperative infections after abdominal surgery by [11][12][13][14][15] comparing outcome after transfusions of non-filtered red blood cells or red blood cells with leucocytes filtered out. Three of these trials [13][14][15] observed a reduction and two 11 12 found a similar incidence of postoperative infections after filtered transfusions.…”