Autologous versus allogeneic transfusion in aortic surgery: a multicenter randomized clinical trial.
OBJECTIVE
To evaluate the efficacy of acute normovolemic hemodilution (ANH) and intraoperative cell salvage (ICS) in blood-conservation strategies for infrarenal aortic surgery.


BACKGROUND
Recent concerns over the risks of transfusion-related infection have resulted in sharp rises in the cost of blood preparations. Autologous transfusion may be a safe alternative to allogeneic transfusion, which has been associated with immune modulation and postoperative infection.


METHODS
This multicenter prospective randomized trial compared standard transfusion practice with autologous transfusion combining ANH with ICS in 145 patients undergoing elective aortic surgery. The primary outcome measures were the proportion of patients requiring allogeneic blood and the volume of allogeneic transfusion. The secondary outcome measures were the frequency of complications, including postoperative infection, and postoperative hospital stay.


RESULTS
The combination of ANH and ICS reduced the volume of allogeneic blood transfused from a median of two units to zero units. The proportion of patients transfused was 56% in allogeneic and 43% in autologous. There were no significant differences in complications or length of hospital stay.


CONCLUSIONS
Both ANH and ICS were safe and reduced the allogeneic blood requirement in patients undergoing elective infrarenal aortic surgery.
Wong
Julian C L
JC
Academic Surgery Unit, Wythenshawe Hospital, Manchester, United Kingdom.
Torella
Francesco
F
Haynes
Sarah L
SL
Dalrymple
Kirsteen
K
Mortimer
Andrew J
AJ
McCollum
Charles N
CN
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery; D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous / Q000009:adverse effects; D003625:Data Collection; D003627:Data Interpretation, Statistical; D005260:Female; D006438:Hemodilution; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D018401:Sample Size; D065227:Transfusion Reaction
D006454:Hemoglobins