title: Differential effects of plasma and red blood cell transfusions on acute lung injury and infection risk following liver transplantation.
abstract: Patients with chronic liver disease have an increased risk of developing transfusion-related acute lung injury (TRALI) from plasma-containing blood products. Similarly, red blood cell transfusions have been associated with postoperative and nosocomial infections in surgical and critical care populations. Patients undergoing liver transplantation receive large amounts of cellular and plasma-containing blood components, but it is presently unclear which blood components are associated with these postoperative complications. A retrospective cohort study of 525 consecutive liver transplant patients revealed a perioperative TRALI rate of 1.3% (7/525, 95% confidence interval = 0.6%-2.7%), which was associated with increases in the hospital mortality rate [28.6% (2/7) versus 2.9% (15/518), P = 0.02] and the intensive care unit length of stay [2 (1-11 days) versus 0 days (0-2 days), P = 0.03]. Only high-plasma-containing blood products (plasma and platelets) were associated with the development of TRALI. Seventy-four of 525 patients (14.1%) developed a postoperative infection, and this was also associated with increased in-hospital mortality [10.8% (8/74) versus 2.0% (9/451), P < 0.01] and a prolonged length of stay. Multivariate logistic regression determined that the number of transfused red blood cell units (adjusted odds ratio = 1.08, 95% confidence interval = 1.02-1.14, P < 0.01), the presence of perioperative renal dysfunction, and reoperation were significantly associated with postoperative infection. In conclusion, patients undergoing liver transplantation have a high risk of developing postoperative complications from blood transfusion. Plasma-containing blood products were associated with the development of TRALI, whereas red blood cells were associated with the development of postoperative infections in a dose-dependent manner.
authors.affiliation: Division of Pulmonary Sciences and Critical Care, University of Colorado, Aurora, CO 80045, USA. alexander.benson@ucdenver.edu
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Benson
authors.forename: James R
authors.initials: JR
authors.lastname: Burton
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Austin
authors.forename: Scott W
authors.initials: SW
authors.lastname: Biggins
authors.forename: Michael A
authors.initials: MA
authors.lastname: Zimmerman
authors.forename: Igal
authors.initials: I
authors.lastname: Kam
authors.forename: Susan
authors.initials: S
authors.lastname: Mandell
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Silliman
authors.forename: Hugo
authors.initials: H
authors.lastname: Rosen
authors.forename: Marc
authors.initials: M
authors.lastname: Moss
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology* / Q000401:mortality; D016913:Blood Component Transfusion / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D003120:Colorado; D003428:Cross Infection / Q000209:etiology* / Q000401:mortality; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome