title: The Leukocyte Antibody Prevalence Study-II (LAPS-II): a retrospective cohort study of transfusion-related acute lung injury in recipients of high-plasma-volume human leukocyte antigen antibody-positive or -negative components.
abstract: BACKGROUND
  We used a multicenter retrospective cohort study design to evaluate whether human leukocyte antigen (HLA) antibody donor screening would reduce the risk of transfusion-related acute lung injury (TRALI) or possible TRALI.
  
  
  METHODS
  In the Leukocyte Antibody Prevalence Study-II (LAPS-II), we evaluated pulmonary outcomes in recipients of 2596 plasma-rich blood components (transfusable plasma and plateletpheresis) sent to participating hospitals; half of the components were collected from anti-HLA-positive donors (study arm) and half from anti-HLA-negative donors (control arm) matched by sex, parity, and blood center. A staged medical record review process was used. Final recipient diagnosis was based on case review by a blinded expert panel of pulmonary or critical care physicians.
  
  
  RESULTS
  TRALI incidence was 0.59% (seven cases) in study arm recipients versus 0.16% (two cases) in control arm recipients for an odds ratio (OR) of 3.6 (95% confidence interval [CI], 0.7-17.4; p = 0.10). For possible TRALI cases (nine study arm, eight control arm), the OR was 1.2 (95% CI, 0.4-3.0; p = 0.81), and for TRALI and possible TRALI aggregated together, it was 1.7 (95% CI, 0.7-3.7; p = 0.24). Transfusion-associated circulatory overload incidence was identical in the two arms (1.17 and 1.22%, respectively; OR, 1.0; p = 1.0).
  
  
  CONCLUSIONS
  TRALI incidence in recipients of anti-HLA-positive components was relatively low for a lookback study (1 in 170) and was higher than in the control arm, but did not reach significance. Based on this trend, the data are consistent with the likelihood that TRALI risk is decreased by selecting high-volume plasma components for transfusion from donors at low risk of having HLA antibodies.
authors: Westat, Inc., Rockville, Maryland, USA. skleinman@shaw.ca
authors: Steven H
authors: SH
authors: Kleinman
authors: Darrell J
authors: DJ
authors: Triulzi
authors: Edward L
authors: EL
authors: Murphy
authors: Patricia M
authors: PM
authors: Carey
authors: Jerome L
authors: JL
authors: Gottschall
authors: John D
authors: JD
authors: Roback
authors: Danielle
authors: D
authors: Carrick
authors: Sunitha
authors: S
authors: Mathew
authors: David J
authors: DJ
authors: Wright
authors: Ritchard
authors: R
authors: Cable
authors: Paul
authors: P
authors: Ness
authors: Ognjen
authors: O
authors: Gajic
authors: Rolf D
authors: RD
authors: Hubmayr
authors: Mark R
authors: MR
authors: Looney
authors: Ram M
authors: RM
authors: Kakaiya
mesh_terms: D055371:Acute Lung Injury / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000097:blood*; D016913:Blood Component Transfusion / Q000009:adverse effects* / Q000379:methods; D001782:Blood Donors; D015331:Cohort Studies; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk
chemical_list: D000906:Antibodies; D006680:HLA Antigens