Double-blind, randomized controlled trial on the effect of leukocyte-depleted erythrocyte transfusions in cardiac valve surgery.
BACKGROUND
Leukocytes in allogeneic blood transfusions are believed to be the cause of immunomodulatory events. A few trials on leukocyte removal from transfusions in cardiac surgery have been conducted, and they showed inconclusive results. We found in a previous study a decrease in mortality rates and number of infections in a subgroup of more heavily transfused patients.


RESULTS
Patients (n=496) undergoing valve surgery (with or without CABG) were randomly assigned in a double-blind fashion to receive standard buffy coat-depleted (PC) or prestorage, by filtration, leukocyte-depleted erythrocytes (LD). The primary end point was mortality at 90 days, and secondary end points were in-hospital mortality, multiple organ dysfunction syndrome, infections, intensive care unit stay, and hospital stay. The difference in mortality at 90 days was not significant (PC 12.7% versus LD 8.4%; odds ratio [OR], 1.52; 95% confidence interval [CI], 0.84 to 2.73). The in-hospital mortality rate was almost twice as high in the PC group (10.1% versus 5.5% in the LD group; OR, 1.99; 95% CI, 0.99 to 4.00). The incidence of multiple organ dysfunction syndrome in both groups was similar, although more patients with multiple organ dysfunction syndrome died in the PC group. LD was associated with a significantly reduced infection rate (PC 31.6% versus LD 21.6%; OR, 1.64; 95% CI, 1.08 to 2.49). In both groups, intensive care unit stay and hospital stay were similar, and postoperative complications increased with the number of transfused units.


CONCLUSIONS
Mortality at 90 days was not significantly different; however, a beneficial effect of LD in valve surgery was found for the secondary end points of in-hospital mortality and infections.
Bilgin
Y M
YM
Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands. m.y.bilgin@lumc.nl
van de Watering
L M G
LM
Eijsman
L
L
Versteegh
M I M
MI
Brand
R
R
van Oers
M H J
MH
Brand
A
A
D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007239:Infections / Q000453:epidemiology; D007362:Intensive Care Units; D007902:Length of Stay; D047589:Leukocyte Reduction Procedures; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality