Perioperative blood transfusion is associated with a gene transcription profile characteristic of immunosuppression: a prospective cohort study

Abstract

Introduction: Blood transfusion in the perioperative period has frequently been associated with an excess of nosocomial infections. Whilst transfused whole blood induces specific host immune alteration that may predispose to nosocomial infections, the immunomodulating properties associated with leukodepleted blood remain incompletely understood. In this study, we explore the hypothesis that the transfusion of leukodepleted allogeneic blood during or following major gastrointestinal surgery is associated with an immunosuppressed phenotype, which may in turn predispose to postoperative infectious complications. Methods: Patients aged over 45 years undergoing scheduled inpatient major gastrointestinal surgery were recruited. Gene expression profiles of specific inflammatory genes were assayed from blood collected preoperatively, at 24 and at 48 hours after surgery. Genes were selected based on their ability to represent specific immune pathways. Gene expression was quantified using quantitative real-time polymerase chain reaction (qRT-PCR) to measure messenger RNA (mRNA) levels. Postoperative infections were documented using predefined criteria.

The European Hematology Association Roadmap for European Hematology Research: a consensus document

“…Besides transfusion-transmitted infections, harm caused by transfusion results from transfusioninduced alloimmunization and transfusion-related immunomodulation, causing (transient) immune suppression. 276 Transfusion represents a huge (economic) market, albeit with a wide range of use in Europe. Reported by 32 of 47 Section 7.…”

Features of Postoperative Immune Suppression Are Reversible With Interferon Gamma and Independent of Interleukin-6 Pathways

“…1,4,8 Although the immune suppressive effect of major tissue damage has been shown to be reversible with interferon gamma (IFN-γ) treatment in the context of traumatic injuries, [10][11][12] in the perioperative period the specific additional immunomodulating effects attributable to such factors as prolonged anaesthetic administration, opioid analgesics, premorbid conditions and blood transfusion require further consideration. [13][14][15] There is similar consistency amongst the transcriptomic data available following tissue damage and major surgery. 6,16,17 A striking feature is the elevation in IL-6 levels in patients with features of functional immune suppression and the correlation between circulating levels of this cytokine and infectious complications.…”

Patient blood management

“…During the 2 recent decades, safety aspects dramatically increased, concomitantly the risk of infections decreased. However, obstacles still remain and have not been resolved yet: risk of nosocomial infections and recurrence of tumor growth [11]. Whitlock et al recently analyzed more than 1.5 million patients, retrospectively to determine whether transfusion of RBC may or may not increase the risk for ischemic stroke and myocardial infarction.…”