Leukoreduction program for red blood cell transfusions in coronary surgery: association with reduced acute kidney injury and in-hospital mortality.
OBJECTIVE
Leukocytes in allogeneic blood transfusions cause several immunomodulatory events. This before-and-after cohort study evaluated clinical outcomes after adoption of prestorage leukoreduction program for blood transfusions, with particular focus on acute kidney injury.


METHODS
One thousand thirty-four consecutive patients who underwent on-pump coronary artery bypass grafting between January 2004 and December 2007 were included. Propensity score analysis for transfusion was performed in the whole population; patients who were actually transfused were then divided according to leukoreduction. From these 2 groups, 147 pairs matched for propensity score were considered to evaluate with bivariate and multivariable analyses the effects of leukoreduction, with all-cause in-hospital mortality and morbidity as main outcomes.


RESULTS
Unadjusted in-hospital mortalities were 6.6% for the entire cohort and 44.2% for those with acute kidney injury. In the matched population, after introduction of leukoreduction, mortality rates decreased to 5.4% (vs 11.4%) and acute kidney injury (RIFLE [Risk, Injury, Failure, Loss of function, End-stage renal disease] class R or greater) dropped from 51.7% to 41.5% (relative risk -20%, P < .045). No difference emerged regarding other major complications. At multivariable analysis, intra-aortic balloon pump, RIFLE score, and propensity score for transfusion proved independent predictors of in-hospital mortality. Intra-aortic balloon pump and nonleukodepleted transfusion emerged as independent predictors of acute kidney injury. Multivariable analysis on the overall cohort of transfused patients confirmed that nonleukodepleted transfusion was an independent predictor of acute kidney injury.


CONCLUSIONS
Leukoreduction of allogeneic blood products is associated with decreased acute kidney injury and mortality in highly transfused patients.
Romano
Gianpaolo
G
Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
Mastroianni
Ciro
C
Bancone
Ciro
C
Della Corte
Alessandro
A
Galdieri
Nicola
N
Nappi
Gianantonio
G
De Santo
Luca Salvatore
LS
D000046:Academic Medical Centers; D000208:Acute Disease; D000368:Aged; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality*; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D007674:Kidney Diseases / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D047589:Leukocyte Reduction Procedures; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome