title: The effect of blood transfusion on pulmonary permeability in cardiac surgery patients: a prospective multicenter cohort study.
abstract: BACKGROUND
  There is an association between blood transfusion and pulmonary complications in cardiac surgery. Mediators of increased pulmonary vascular leakage after transfusion are unknown. We hypothesized that factors may include antibodies or bioactive lipids, which have been implicated in transfusion-related acute lung injury.
  
  
  METHODS
  We performed a prospective cohort study in two university hospital intensive care units in the Netherlands. Pulmonary vascular permeability was measured in cardiac surgery patients after receiving no, restrictive (one or two transfusions), or multiple (five or more transfusions) transfusions (n=20 per group). The pulmonary leak index (PLI), using (67) Ga-labeled transferrin, was determined within 3 hours postoperatively. Blood products were screened for bioactive lipid accumulation and the presence of antibodies.
  
  
  RESULTS
  The PLI was elevated in all groups after cardiac surgery. Transfused patients had a higher PLI compared to nontransfused patients (33×10(-3) ± 20×10(-3) vs. 23×10(-3) ± 11×10(-3)/min, p<0.01). The amount of red blood cell (RBC) products, but not of fresh-frozen plasma or platelets, was associated with an increase in PLI (β, 1.6 [0.2-3.0]). Concerning causative factors in the blood product, neither the level of bioactive lipids nor the presence of antibodies was associated with an increase in PLI. Patient factors such as surgery risk and time on cardiopulmonary bypass did not influence the risk of pulmonary leakage after blood transfusion.
  
  
  CONCLUSIONS
  Transfusion in cardiothoracic surgery patients is associated with an increase in pulmonary capillary permeability, an effect that was dose dependent for RBC products. The level of bioactive lipids or the presence of HLA or HNA antibodies in the transfused products were not associated with increased pulmonary capillary permeability.
authors: Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands. a.p.vlaar@amc.uva.nl
authors: Alexander P J
authors: AP
authors: Vlaar
authors: Alexander D
authors: AD
authors: Cornet
authors: Jorrit J
authors: JJ
authors: Hofstra
authors: Leendert
authors: L
authors: Porcelijn
authors: Albertus
authors: A
authors: Beishuizen
authors: Willem
authors: W
authors: Kulik
authors: Margreeth B
authors: MB
authors: Vroom
authors: Marcus J
authors: MJ
authors: Schultz
authors: A B Johan
authors: AB
authors: Groeneveld
authors: Nicole P
authors: NP
authors: Juffermans
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology*; D012307:Risk Factors; D065227:Transfusion Reaction