title: Impact of ABO-identical vs ABO-compatible nonidentical plasma transfusion in trauma patients.
abstract: OBJECTIVE
  Exposure to ABO-compatible nonidentical plasma will result in worse outcomes than transfusion with ABO-identical plasma only.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  All patients requiring plasma (from 2000-2008) were identified. Propensity scores were used to match patients exposed to ABO-compatible plasma with those receiving exclusively ABO-identical plasma.
  
  
  METHODS
  Mortality and complications (acute respiratory distress syndrome [ARDS]), sepsis, renal failure, and liver failure).
  
  
  RESULTS
  A total of 284 patients who received ABO-compatible nonidentical plasma were matched 1:1 with patients who received ABO-identical plasma only (230 group O, 39 A, and 15 B). ABO-compatible plasma did not affect mortality (35.2% vs 33.5%, P = .66). However, the overall complication rate was significantly higher for patients receiving ABO-compatible plasma (53.5% vs 40.5%, P = .002). The ARDS and sepsis rates were also significantly increased (19.4% vs 9.2%, P = .001, and 38.0% vs 28.9%, P = .02, respectively). As the volume of ABO-compatible plasma infused increased, a stepwise increase in complications was seen, reaching 70.0% for patients receiving more than 6 U. Patients receiving more than 6 U also had a 4-fold increase in ARDS. All recipient blood groups had an increase in overall complications, ARDS, and sepsis with exposure. This was significant for group O recipients with a higher risk of overall complications and ARDS (50.9% vs 40.0%, P = .03, and 17.4% vs 7.8%, P < .001, respectively).
  
  
  CONCLUSIONS
  Exposure to ABO-compatible plasma results in an increase in overall complications, in particular ARDS and sepsis. There is a stepwise increase in the complication rate as exposure increases. Further prospective evaluation of the impact of limiting factor replacement to ABO-identical plasma only is warranted.
authors.affiliation: Division of Trauma and Surgical Critical Care, University of Southern California, 1200 N State Street, Los Angeles, CA 90033-4525, USA. kinaba@surgery.usc.edu
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Bernardino C
authors.initials: BC
authors.lastname: Branco
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
authors.forename: Ira
authors.initials: I
authors.lastname: Shulman
authors.forename: Janice
authors.initials: J
authors.lastname: Nelson
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D016913:Blood Component Transfusion / Q000009:adverse effects; D001787:Blood Group Incompatibility / Q000276:immunology; D001800:Blood Specimen Collection; D005260:Female; D005615:Freezing; D006650:Histocompatibility Testing; D006801:Humans; D007902:Length of Stay; D017093:Liver Failure / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000276:immunology*; D011183:Postoperative Complications / Q000453:epidemiology; D051437:Renal Insufficiency / Q000453:epidemiology; D012128:Respiratory Distress Syndrome / Q000453:epidemiology*; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology*; D013997:Time Factors
chemical_list: D000017:ABO Blood-Group System