Moderate Exposure to Allogeneic Blood Products Is Not Associated with Reduced Long-term Survival after Surgery for Coronary Artery Disease

Abstract

Background: It has been suggested that blood transfusion has an adverse effect on long-term health, mainly through immune modulation and tumor promotion. To further assess this concern, the authors have performed a prospective observational study with the hypothesis that after taking perioperative risk factors relevant to long-term survival into account, patients undergoing coronary artery surgery who receive a perioperative allogeneic blood transfusion have worse long-term survival than those who do not.Methods: The health outcomes of 1,841 consecutive subjects who had isolated nonemergency first-time coronary artery surgery and who survived more than 60 days after surgery were determined by record linkage. The association between length of survival, blood products transfused, and risk factors for longterm survival at entry to the study were determined by Cox proportional hazards regression.Results: A total of 1,062 subjects were transfused. Of these, 266 subjects died during a mean follow-up of 8.1 yr. Of subjects who were transfused, 27% had a new malignant condition recorded on the death certificate, compared with 43% who were not transfused. Older age, cerebrovascular disease, use of a mammary graft, chronic pulmonary disease, renal dysfunction, reduced left ventricular function, and preoperative anemia were predictive of reduced long-term survival. There was no association between transfusion of blood products and longterm survival.Conclusions: Patients who have undergone coronary artery surgery and who have received moderate amounts of blood as part of responsible and conservative management should be reassured that they are unlikely to experience a reduction in long-term survival.

A systematic review of the effect of red blood cell transfusion on mortality: evidence from large-scale observational studies published between 2006 and 2010

“…Full articles were retrieved for 45 studies; 13 further studies were excluded as they did not fulfil our eligibility criteria (see online supplementary appendix 2 for list of excluded studies). Thirty-two studies were included in the review; 23 7-30 studies assessed the effects of RBCT versus no RBCT, 5 studies [31][32][33][34][35] assessed different volumes of RBCT and 4 [36][37][38][39] assessed giving older versus newer RBCT (see figure 1). …”

“…Volume 'A' red blood versus volume 'B' red blood cells Five studies [31][32][33][34][35] assessed the effects of different volumes of RBCT on mortality. One of these studies 35 included both RBCT and other blood products.…”

“…One study assessed a prospective cohort and followed up a planned group of patients, 35 whereas the other four studies assessed data from a retrospective patient registry or database. Two of the studies 33 35 specifically looked at adults undergoing cardiac surgery, one was on trauma patients, 32 one was on patients undergoing major surgery 31 and one on patients in the intensive care unit.…”

Risks of packed red blood cell transfusion in patients undergoing cardiac surgery

“…A transfusion volume of greater than 3 units was an independent predictor of early mortality but did not appear to affect long-term mortality. Conversely, Weightman et al [31], in a study of more than 1800 patients, just more than 1000 of whom were transfused, found that transfusion of less than 6 units of PRBC was not [32] and Veenith et al [33] have determined that PRBC transfusion in this patient population is an independent risk factor not only for increased mortality but also for prolonged intensive care unit length of stay. Most recently, a randomized, prospective trial of more than 500 patients, the Transfusion Requirements After Cardiac Surgery Study, comparing a "liberal" transfusion arm (keeping Hct N 30%) and a "restrictive" arm (transfusing only when Hct fell to b24%), has been published [34].…”

Η Επίδραση Της Στρατηγικής Περιορισμού Των Ενδοφλεβίως Χορηγούμενων Υγρών Στον Αριθμό Των Μεταγγιζόμενων Μονάδων Συμπυκνωμένων Ερυθρών Στις Καρδιοχειρουργικές Επεμβάσεις Με Εξωσωματική Κυκλοφορία

“…∆εδοµένα πολλών µελετών υποστηρίζουν ότι οι µεταγγίσεις αίµατος σχετίζονται µε αυξηµένη θνησιµότητα και θνητότητα στις καρδιοχειρουργικές επεµβάσεις [891,892]. Παρόλα αυτά, µια πρόσφατη µεγάλη µελέτη παρατήρησης δεν έδειξε κάποια σχέση µεταξύ µιας µέτριας (≤6 µονάδες) χρήσης παραγώγων αίµατος και ελάττωσης της επιβίωσης µακροπρόθεσµα [893]. Καθώς ο κίνδυνος για ανεπιθύµητα συµβάντα που σχετίζονται µε τη µετάγγιση είναι δυνατόν να συνδέεται µε το ποσοστό αυτής [894], η µείωση των µεταγγίσεων θεωρείται ένας σηµαντικός στόχος στις καρδιοχειρουργικές επεµβάσεις, άµεσα συνδεόµενος µε αυτές.…”