HLA and RBC immunization after filtered and buffy coat‐depleted blood transfusion in cardiac surgery: a randomized controlled trial

Watering, Leo van de; Hermans, J.; Witvliet, Marian D.; Versteegh, Michel I.M.; Brand, Anneke

doi:10.1046/j.1537-2995.2003.00390.x

Cited by 70 publications

(66 citation statements)

References 29 publications

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“…Prestorage filter leucodepletion was universally implemented in the Netherlands in 2001. It appears that the alloimmunization risk is not affected by this [33,34].…”

Section: Methodsmentioning

confidence: 88%

Early occurrence of red blood cell alloimmunization in patients with sickle cell disease

et al. 2016

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Red blood cell (RBC) alloimmunization is a major complication of transfusion therapy in sickle cell disease (SCD). Identification of high-risk patients is hampered by lack of studies that take the cumulative transfusion exposure into account. In this retrospective cohort study among previously non-transfused SCD patients in the Netherlands, we aimed to elucidate the association between the cumulative transfusion exposure, first alloimmunization and independent risk factors. A total of 245 patients received 11 952 RBC units. Alloimmunization occurred in 43 patients (18%), half of them formed their first alloantibody before the 8th unit. In patients with exposure to non-extended matched transfusions (ABO and RhD) the cumulative alloimmunization risk increased up to 35% after 60 transfused units. This was significantly higher compared to a general transfused population (HR 6.6, CI 4.2-10.6). Receiving the first transfusion after the age of 5 was an independent risk factor for alloimmunization (HR 2.3, CI 1.0-5.1). Incidental, episodic transfusions in comparison to chronic scheme transfusions (HR 2.3, CI 0.9-6.0), and exposure to non-extended matched units in comparison to extended matching (HR 2.0, CI 0.9-4.6) seemed to confer a higher alloimmunization risk. The majority of first alloantibodies are formed after minor transfusion exposure, substantiating suggestions of a responder phenotype in SCD and stressing the need for risk factor identification. In this study, older age at first transfusion, episodic transfusions and non-extended matched transfusions appeared to be risk factors for alloimmunization.

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“…Prestorage filter leucodepletion was universally implemented in the Netherlands in 2001. It appears that the alloimmunization risk is not affected by this [33,34].…”

Section: Methodsmentioning

confidence: 88%

Early occurrence of red blood cell alloimmunization in patients with sickle cell disease

et al. 2016

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“…However, alloimmunization rates reported in the pre-LD era in patients following a single transfusion episode were 5-8% (Redman et al, 1996;van de Watering et al, 2003). This meant that to conduct a randomized trial powered to detect a clinically significant increase in alloimmunization, thousands of patients would have been needed.…”

mentioning

confidence: 99%

Transfusion of prion‐filtered red cells does not increase the rate of alloimmunization or transfusion reactions in patients: results of the UK trial of prion‐filtered versus standard red cells in surgical patients (PRISM A)

et al. 2013

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SummaryThis study, conducted for the UK Blood Transfusion Services (UKBTS), evaluated the clinical safety of red cells filtered through a CE-marked prion removal filter (P-Capt). Patients requiring blood transfusion for elective procedures in nine UK hospitals were entered into a non-randomized open trial to assess development of red cell antibodies to standard red cell (RCC) or prion-filtered red cell concentrates (PF-RCC) at eight weeks and six months post-transfusion. Patients who received at least 1 unit of PF-RCC were compared with a control cohort given RCC only. About 917 PF-RCC and 1336 RCC units were transfused into 299 and 291 patients respectively. Twenty-six new red cell antibodies were detected post-transfusion in 10 patients in each arm, an overall alloimmunization rate of 4Á4%. Neither the treatment arm [odds ratio (OR) 0Á93, 95% confidence interval (CI) 0Á3, 2Á5] nor number of units transfused (OR 0Á95, 95% CI 0Á8, 1Á1) had a significant effect on the proportion of patients who developed new alloantibodies. No pan-reactive antibodies or antibodies specifically against PF-RCC were detected. There was no difference in transfusion reactions between arms, and no novel transfusion-related adverse events clearly attributable to PF-RCC were seen. These data suggest that prion filtration of red cells does not reduce overall transfusion safety. This finding requires confirmation in large populations of transfused patients.

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“…Limited literature also exists in other, nonrenal patient populations. Recently, Van de Watering et al (28) randomized Ͼ400 patients who were undergoing cardiac surgery to receive either standard or leukoreduced RBC transfusions and observed no difference in allosensitization rates in either unsensitized or previously sensitized patients.…”

Section: Discussionmentioning

confidence: 99%

Leukocyte Reduction of Red Blood Cell Transfusions Does not Decrease Allosensitization Rates in Potential Kidney Transplant Candidates

Karpinski¹,

Pochinco²,

Dembinski³

et al. 2004

Journal of the American Society of Nephrology

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Abstract. A significant proportion of potential kidney transplant candidates continue to periodically require blood transfusions that carry a risk of allosensitization. Leukocyte reduction (leukoreduction) of blood products has been proved to reduce transfusion-associated allosensitization in patients with hematologic malignancies; however, the effect in potential kidney transplant candidates is unknown. A total of 112 kidney transplant candidates who received red blood cell transfusions while on the transplant waiting list were identified retrospectively. Sixty received a transfusion before leukoreduction (non-LR), and 52 received a transfusion after the local implementation of universal leukoreduction of blood products (LR). There was no difference in transfusion-associated allosensitization rates in patients who received a transfusion during the two eras (non-LR 27% [16 of 60] versus LR 33% [17/52]; NS). Likewise, no difference was observed in subgroups identified as being at high risk of allosensitization (previous pregnancy, transplant, or five or more previous transfusions) or at low risk (no previous allogeneic exposures) (high risk: non-LR 52% versus LR 55%; low risk: non-LR 10% versus LR 8%). Multivariate analysis revealed previous pregnancy to be the only significant risk factor associated with transfusion-associated allosensitization (relative risk, 8.2; 95% confidence interval, 2.4 to 24.0; P ϭ 0.0001). Leukoreduction, in particular, was not associated with any protective effect. In summary, leukoreduction of red blood cell transfusions does not confer any protection against transfusion-associated allosensitization for potential kidney transplant candidates. Physicians who care for patients with ESRD must continue to practice careful transfusion avoidance while alternative strategies to minimize transfusion associated allosensitization are sought.Despite the fact that recombinant erythropoietins have substantially decreased the need for transfusions in patients with ESRD, United Network for Organ Sharing (UNOS) data indicate that approximately 30% of wait-listed transplant candidates continue to receive red blood cell (RBC) transfusions at some point before transplantation (1, 2). In the past, some transplant programs administered deliberate pretransplant transfusions aimed at optimizing graft outcomes (i.e., the beneficial transfusion effect); however, more recent data indicate that this beneficial effect is no longer apparent, perhaps as a result of improving graft outcomes overall (2-5). Concerns of transfusion-associated allosensitization persist for potential transplant candidates, and it is likely that the majority of current transfusions are administered for other clinical indications.

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HLA and RBC immunization after filtered and buffy coat‐depleted blood transfusion in cardiac surgery: a randomized controlled trial

Abstract: Buffy coat removal, and additional WBC reduction by filtration, either before or after storage, result in similar posttransfusion alloimmunization frequencies after a single transfusion event with multiple RBCs.

Cited by 70 publications

References 29 publications

Early occurrence of red blood cell alloimmunization in patients with sickle cell disease

Early occurrence of red blood cell alloimmunization in patients with sickle cell disease

Transfusion of prion‐filtered red cells does not increase the rate of alloimmunization or transfusion reactions in patients: results of the UK trial of prion‐filtered versus standard red cells in surgical patients (PRISM A)

Leukocyte Reduction of Red Blood Cell Transfusions Does not Decrease Allosensitization Rates in Potential Kidney Transplant Candidates

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