Immunologic Effects of Allogeneic versus Autologous Blood Transfusion in Patients Undergoing Radical Oesophagectomy

Abstract

Blood transfusion is often required in patients undergoing radical oesophagectomy, and is associated with immunosuppression that may worsen postoperative and long-term outcomes. However, the immunologic effects of allogeneic versus autologous transfusion have not been studied in this group of patients. We analyzed 103 patients who underwent radical oesophagectomy for oesophageal cancer, including 45 patients who received allogeneic transfusions (Allo), 16 patients who donated autologous blood but were not transfused (Auto-1) and 42 patients who received autologous transfusions (Auto-2). Peripheral blood lymphocyte subsets and natural killer (NK) cell activity were analyzed for 2 weeks postoperatively. Furthermore, the rate of infectious complications such as pneumonia and wound infection was compared. Patients receiving blood transfusion had decreased CD4+ lymphocyte counts and NK cell activity postoperatively, compared to Auto-1 patients. However, these abnormalities were corrected by day 14 in the Auto-2 group, but not in the Allo group. CD8+ lymphocyte counts were decreased in all groups postoperatively, returning to normal by 14 days in the Auto-1 group only. The rate of infectious complications was significantly higher in the Allo than in the Auto group. Blood transfusion is associated with adverse immunologic effects in patients undergoing radical oesophagectomy. However, autologous blood transfusion is favourable compared to allogeneic transfusion. Autologous transfusion programs should be employed when possible in this group of patients.

Intraoperative Blood Transfusion Contributes to Decreased Long‐Term Survival of Patients With Esophageal Cancer

“…However, patients who required blood transfusion may have a short period of local hypoperfusion in some organs such as liver and lung, potentially enhancing the recurrence or metastatic process via depression of the immune system. Several reports have suggested that blood transfusion is a significant prognostic factor of outcomes in patients who underwent surgical resection of cancer [15,16,30,31]. The mechanisms involved in the adverse effects of red blood cell transfusion may be related to impaired immunity or enhanced inflammation, which may lead to tumor growth or recurrence.…”

“…Intraoperative blood loss and red blood cell transfusion have been reported as prognostic factors for other types of cancer, such as colorectal cancer, gastric cancer, hepatocellular carcinoma, ductal adenocarcinoma of the pancreas, and prostate cancer [11][12][13][14][15]. Although several studies have examined the impact of blood transfusion on prognosis [16,17], there are few studies demonstrating the association between the amount of intraoperative blood loss and the long-term outcome of patients with esophageal SCC following radical esophagectomy. The aim of this study was to determine retrospectively the independent prognostic factors, especially intraoperative factors such as blood loss, after curative resection of esophageal SCC.…”

Human Herpesvirus 8 Infection and Transfusion History in Children With Sickle-Cell Disease in Uganda

“…Children with sickle-cell disease receive blood transfusions for a variety of reasons, such as severe malaria or sickle-cell crisis, but we are aware of no data suggesting that these conditions predispose children to HHV-8 infection. Still, heterologous blood transfusions have been reported to cause transient immunosuppression (35), and the higher prevalence of HHV-8 infection could conceivably be the result of heightened susceptibility in transfused children to infection from other sources. Nonetheless, in additional analyses stratified on number of blood transfusions, we did not obtain differing estimates of the risk for community-acquired infection (data not shown), suggesting that it is unlikely that transfusions serve merely as a marker for poor overall health and increased risk for community-acquired HHV-8 infection.…”

Dysfunctional Natural Killer Cells in the Aftermath of Cancer Surgery

“…Gharehbaghian et al demonstrated that use of autologous salvaged blood, instead of allogenic blood for transfusion, increased the proportion of NK cell precursors and IFNγ production post-surgery [ 81 ]. However, there was no difference in autologous vs. allogenic blood transfusion in NK cell cytotoxicity in Takemura’s study [ 82 ]. These results may be explained by the fact that blood transfusions themselves will result in immunosuppression.…”