The influence of homologous blood transfusion on immunity and clinical outcome in aortic surgery.
OBJECTIVE
To evaluate the influence of homologous blood transfusion on immune responses and post-operative morbidity in aortic surgery.


METHODS
Analysis of the effects of homologous blood transfusion in 128 patients in a prospective randomised trial evaluating homologous and autologous blood transfusion in aortic surgery.


METHODS
Blood sampled before and at five times after surgery was assayed for C-reactive protein (CRP), neutrophil elastase, TNF-alpha and IL-6. Transfusions, morbidity and mortality were recorded; factors associated with poor outcome were identified by logistic regression.


RESULTS
homologous transfusion during surgery was required in 32 patients and precipitated an increase in neutrophil elastase (p=0.008) and TNF-alpha (p=0.015) but not IL-6 and CRP. Elastase peaked early in transfused patients at 41.27 (13.92-52.11) Deltang/ml by 2 h compared to a peak of 21.51 (10.64-31.13) Deltang/ml by 24 h in those who were not transfused. TNF-alpha peaked at 1.2 (0-4.33) Deltapg/ml by wound closure in transfused patients and at -0.1 (-2.05-2.52) Deltapg/ml by 2 h without transfusion. Intra-operative homologous transfusion was associated with increased mortality (p=0.01) and prolonged intensive care stay (p=0.03). Mortality increased with age (p=0.003) and was inversely related to the CRP peak (p=0.007). Prolonged surgery predicted post-operative complications (p=0.025).


CONCLUSIONS
Homologous transfusion increased the inflammatory response to aortic surgery and was associated with mortality.
Haynes
S L
SL
Academic Surgery Unit, South Manchester University Hospital, Manchester, West Didsbury, M20 2LR, UK.
Wong
J C
JC
Torella
F
F
Dalrymple
K
K
Pilsworth
L
L
McCollum
C N
CN
D000368:Aged; D001011:Aorta / Q000601:surgery*; D001803:Blood Transfusion / Q000379:methods*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis*; D007431:Intraoperative Complications / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D014181:Transplantation Immunology / Q000502:physiology*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality
D018836:Inflammation Mediators