title: Impact of pre-storage and bedside filtered leukocyte-depleted blood transfusions on infective morbidity after colorectal resection: a single-center analysis of 437 patients.
abstract: BACKGROUND
  Leukocyte-depleted blood transfusions were introduced to reduce transfusion-associated immunomodulation, but the clinical effects of different types of leukocyte depletion have been analyzed rarely. The aim of this survey was to analyze the clinical impact of pre-storage leukocyte-depleted blood transfusions (considered as pre-storage or bedside-filtered) on post-operative complications in patients undergoing elective or urgent colorectal resection.
  
  
  METHODS
  Data were collected retrospectively from the medical records of 437 consecutive patients who underwent colorectal resection from 2005 to 2010. All patients requiring transfusion received pre-storage or bedside-filtered leukocyte-depleted red blood cell concentrates according to availability at the blood bank. The outcomes were measured by the analysis of post-operative morbidity in patients receiving the different types of transfusions or having other potentially predictive risk factors.
  
  
  RESULTS
  The overall morbidity rate, infective morbidity rate, and non-infective morbidity rate were, respectively, 35.6%, 28.1%, and 21.0%. Two hundred five patients (46.9%) received peri-operative transfusions. On multivariable analysis, leukocyte-depleted transfusion (odds ratio [OR] 3.33; 95% confidence interval [CI] 2.14-5.20; p<0.001) and both pre-storage (OR 2.82; 95% CI 1.73-4.59; p<0.001) and bedside-filtered (OR 4.69; 95% CI 2.54-8.67; p<0.001) transfusions were independent factors for post-operative morbidity. Prolonged operation (p=0.035), American Society of Anesthesiologists score≥3 points (p=0.023), diagnosis of cancer rather than benign disease (p=0.022), and urgent operation (p=0.020) were other independent predictors of post-operative complications. Patients transfused with bedside-filtered blood showed significantly higher rates of infective complications (51.4% vs. 31.8%; p=0.006), but not non-infectious complications (35.7% vs. 32.6; p=0.654) than patients who received pre-storage transfusions.
  
  
  CONCLUSIONS
  Leukocyte-depleted blood transfusions and, in particular, bedside-filtered blood have a significant negative effect on infectious complications after colorectal resection.
authors.affiliation: Department of General Surgery, San Gerardo Hospital, University of Milano-Bicocca , Monza MB, Italy. mattia_garancini@yahoo.it
authors.forename: Mattia
authors.initials: M
authors.lastname: Garancini
authors.forename: Luca
authors.initials: L
authors.lastname: Degrate
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Carpinelli
authors.forename: Matteo
authors.initials: M
authors.lastname: Maternini
authors.forename: Fabio
authors.initials: F
authors.lastname: Uggeri
authors.forename: Laura
authors.initials: L
authors.lastname: Giordano
authors.forename: Franco
authors.initials: F
authors.lastname: Uggeri
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Romano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001803:Blood Transfusion / Q000379:methods* / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D003082:Colectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D047589:Leukocyte Reduction Procedures / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies