Risk factors for posttransfusion graft versus host disease, mediastinitis, and late cardiac tamponade in heart surgery. Survey of 119 Japanese institutions.
OBJECTIVE
Correlations and risk factors remain to be unclarified for post-heart-surgery posttransfusion graft-versus-host disease, mediastinitis, and late cardiac tamponade caused by deteriorated host-defense mechanisms due to cardiopulmonary bypass both with and without steroid usage.


METHODS
We sent questionnaires to 298 Japanese cardiovascular institutions asking for institution profiles, including infection control, steroid use in cardiopulmonary bypass, and prevalence of mediastinitis, late cardiac tamponade, and posttransfusion graft-versus-host disease during 1994. The overall prevalence of posttransfusion graft-versus-host disease since the start of service (from establishment of institution to date) was also requested.


RESULTS
The number of pump cases at the 119 institutions responding (40%) were 91.6 +/- 67.9 cases/institution (total = 10,904). The prevalence of mediastinitis was 1.2 +/- 1.8 and that of late cardiac tamponade 1.0 +/- 1.8%. Posttransfusion graft-versus-host disease occurred in 1 of 10,904 patients (0.01%) during 1994 at an institution where steroids and nonirradiated blood were used in surgery. The simple institutional mean prevalence of posttransfusion graft-versus-host disease since establishing institutions was 0.08 +/- 0.13%. Of the 119 institutions surveyed, 86 used steroids in all pump cases (72%); 11 institutions used steroids in a limited number of cases (9%). The institutional mean of methylprednisolone-converted steroid dose was 21.5 +/- 16.4 mg/kg (n = 119). In multivariate regression analysis, operation time (p = 0.005) for mediastinitis, steroid usage (all, limited, or no cases) (p = 0.01) and % aneurysm (p = 0.05) for late cardiac tamponade, and steroid dosage (p = 0.002) for posttransfusion graft-versus-host disease were identified as significant risk factors.


CONCLUSIONS
Our results suggest that massive steroid administration for cardiopulmonary bypass may increase the risk of posttransfusion graft-versus-host disease and late cardiac tamponade, but not mediastinitis.
Mayumi
H
H
Department of Cardiovascular Surgery, National Kyushu Medical Center Hospital, Japan.
Nakashima
A
A
Nishimi
M
M
Hirano
A
A
Yamamoto
E
E
Kawachi
Y
Y
Yasui
H
H
Tokunaga
K
K
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data; D002305:Cardiac Tamponade / Q000453:epidemiology* / Q000209:etiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008480:Mediastinitis / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids; D011795:Surveys and Questionnaires; D065227:Transfusion Reaction
D000893:Anti-Inflammatory Agents; D013256:Steroids