Randomised controlled trial comparing transfusion of leucocyte-depleted or buffy-coat-depleted blood in surgery for colorectal cancer

Houbiers, J. G. A.; Brand, Anneke; Watering, Leo M.G. van de; Velde, Cornelis J.H. van de; Hermans, J.; Verwey, P.J.M.; Bijnen, A. B.; Pahlplatz, Paul V. M.; Schattenkerk, M Eeftink; Wobbes, Th.; Vries, J.E. de; Klementschitsch, P; Maas, Anne

doi:10.1016/s0140-6736(94)91965-8

Cited by 372 publications

(329 citation statements)

References 26 publications

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“…[15][16][17][18][19][20] In addition, 7 randomized controlled trials (RCTs) have compared the risk of cancer recurrence 2,21,22 and/or postoperative infection [3][4][5][6][7][21][22][23] between a treatment arm receiving standard 7 or buffy-coat-reduced red blood cells (RBCs) 2,[4][5][6]21,22 or whole blood 3 and a control arm receiving autologous or white blood cell (WBC)-reduced RBCs or whole blood. 24,25 These studies are based on the assumption that the transfusion of autologous 2,4,21,23 or WBC-reduced 3,[5][6][7]22 RBCs, or whole blood, is immunologically neutral. Both the earlier observational cohort studies and the recent RCTs have produced contradictory findings, and-because of the discrepancies among the published studies-the long-standing hypothesis of the potentially deleterious immunomodulatory effect of perioperative allogeneic blood transfusion remains unresolved.…”

mentioning

confidence: 99%

Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction?

Vamvakas

Blajchman

2001

Blood

388

272

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mentioning

confidence: 99%

Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction?

Vamvakas

Blajchman

2001

Blood

388

272

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“…[42][43][44] Nevertheless, autologous or leukocyte-depleted transfusions did not improve outcomes for colorectal cancer patients, 45,46 suggesting that other non-immune-mediated factors may be responsible for poor outcomes. 47,48 Based on the information available in the present study, it is not possible to determine whether some unmeasured confounders may have contributed to our findings. Nevertheless, the results of two recent studies showed that perioperative blood transfusions were associated with worse oncological outcomes in patients with bladder cancer, albeit only in univariable analyses.…”

Section: Perioperative Transfusion and Oncological Outcomesmentioning

confidence: 86%

Perioperative management and oncological outcomes following radical cystectomy for bladder cancer: a matched retrospective cohort study

Weingarten

Taccolini

Ahle

et al. 2016

Can J Anesth/J Can Anesth

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“…By contrast, another study showed no differences in postoperative infections after colorectal cancer surgery between patients receiving leukoreduced versus nonleukoreduced RBCs. 38 Even if a recent review by Cata and colleagues 9 argues that there is no strong evidence that a mitigation of the immunomodulatory effect of RBC transfusion can be ascribed to leukoreduction, three detailed meta-analyses provided the effectiveness of leukoreduction in reducing postoperative infection. [39][40][41] Leukoreduction mitigates postoperative infection with a RR reduction of approximately 35%.…”

Section: Subgroup Analysismentioning

confidence: 99%

The effects of storage of red blood cells on the development of postoperative infections after noncardiac surgery

et al. 2017

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BACKGROUND: Prolonged storage of red blood cells (RBCs) is a potential risk factor for postoperative infections. The objective of this study was to examine the effect of age of RBCs transfused on development of postoperative infection. STUDY DESIGN AND METHODS: In thisprospective, double-blind randomized trial, 199 patients undergoing elective noncardiac surgery and requiring RBC transfusion were assigned to receive nonleukoreduced RBCs stored for not more than 14 days ("fresh blood" group, n 5 101) or for more than 14 days ("old blood" group, n 5 98). The primary outcome was occurrence of infection within 28 days after surgery; secondary outcomes were postoperative acute kidney injury (AKI), in-hospital and 90-day mortality, admission to intensive care unit, and hospital length of stay (LOS). As older blood was not always available, an "as-treated" (AT) analysis was also performed according to actual age of the RBCs transfused. RESULTS:The median [interquartile range] storage time of and 15 [11][12][13][14][15][16][17][18][19][20] days in fresh blood and in old blood groups, respectively. The occurrence of postoperative infection did not differ between groups (fresh blood 22% vs. old blood 25%; relative risk [RR], 1.17; confidence interval [CI], 0.71-1.93), although wound infections occurred more frequently in old blood (15% vs. 5%; RR, 3.09; CI,). Patients receiving older units had a higher rate of AKI (24% vs. 6%; p < 0.001) and, according to AT analysis, longer LOS (mean difference, 3.6 days; CI, 0.6-7.5).CONCLUSION: Prolonged RBC storage time did not increase the risk of postoperative infection. However, old blood transfusion increased wound infections rate and incidence of AKI. Immunosuppression induced by surgery and anesthesia may be aggravated by transfusion. 9 Most studies in trauma and cardiac surgery reported that prolonged RBC storage was a risk factor for postoperative infections after cardiac surgery, 10-12 but the same association was not found in liver transplantation 13 or orthopedic surgery. 14 A recent systematic review 15 that analyzed four trials which investigated the nosocomial infections, showed no benefits in receiving fresh RBCs. However, the authors reported that the results are difficult to interpret because the studies involved different populations and there were considerable differences in the length of storage of fresh and old blood and in study methods. 15To our knowledge, the association of age of RBCs with infections in noncardiac surgery population has not been investigated by double-blind randomized studies. Accordingly, the aim of this study was to investigate the relationship between RBC storage time and postoperative infection after elective noncardiac surgery. In addition, we evaluated the effects of the age of RBCs on other outcomes such as postoperative acute kidney injury (AKI), hospital length of stay (LOS), and 90-day mortality. MATERIALS AND METHODS Study populationThis prospective, randomized, controlled, double-blind clinical trial was conducted between August 2...

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Randomised controlled trial comparing transfusion of leucocyte-depleted or buffy-coat-depleted blood in surgery for colorectal cancer

Cited by 372 publications

References 26 publications

Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction?

Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction?

Perioperative management and oncological outcomes following radical cystectomy for bladder cancer: a matched retrospective cohort study

The effects of storage of red blood cells on the development of postoperative infections after noncardiac surgery

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