title: Male-predominant plasma transfusion strategy for preventing transfusion-related acute lung injury: a systematic review.
abstract: OBJECTIVE
  To assess 1) the effectiveness of male-predominant plasma transfusion strategy for preventing transfusion-related acute lung injury and related mortality; and 2) whether this effect varies across different patient subgroups.
  
  
  METHODS
  Systematic Review and meta-analysis: Data were identified by querying MEDLINE and EMBASE (including proceedings of major conferences on blood transfusions), searching the Internet for hemovigilance reports, reviewing reference lists of eligible articles and contacting experts in the field. Eligible were all studies reporting transfusion-related acute lung injury incidence, all-cause mortality (primary outcomes), hospital length of stay, time to extubation, PaO2/FIO2-ratio or blood pressure changes (secondary outcomes) in recipients of plasma transfusions containing relatively more plasma from individuals at low risk of carrying leukocyte-antibodies ("male plasma") than those receiving comparator plasma ("control plasma"). No limits were placed on study design, population or language. The only exclusion criteria were non-human subjects and lack of control group. Prespecified study quality indicators (including risk of bias assessment) and potential effect modifiers were tested using Cochran's Q Test. Final analyses using random-effects models and I2 to assess heterogeneity were performed in the subset of studies judged to provide the best evidence and separately for significantly different subgroups using STATA 12.1 (StataCorp, College Station, TX).
  
  
  METHODS
  As per primary studies.
  
  
  METHODS
  As per primary studies.
  
  
  METHODS
  As per primary studies (generally: exposure to plasma containing relatively more male plasma than comparator plasma).
  
  
  RESULTS
  From a total of 850 retrieved records, we identified 45 eligible studies. For transfusion-related acute lung injury incidence, final analysis was restricted to 13 cohort studies and one randomized controlled trial in which transfusion-related acute lung injury cases only involved plasma transfusions. Risk of transfusion-related acute lung injury and mortality in plasma recipients exposed to men when compared with control plasma were 0.27 (95% CI, 0.20-0.38; p < 0.001; I = 0%; n = 14; 286 events) and 0.89 (95% CI, 0.80-1.00; p = 0.04; I = 79%; n = 7; 5, 710 events), respectively. No other significant interactions were found. Secondary outcomes showed similar results but were less reported and the studies were more heterogeneous. Sensitivity analyses did not alter the results. There was no evidence of publication bias.
  
  
  CONCLUSIONS
  More than 800 million people in 17 countries are subject to male-predominant plasma transfusion policy and at least three more countries are planning or considering adoption of this strategy. On the basis of most observational data, judged to be of high quality, male-predominant plasma transfusion strategy reduces plasma-related transfusion-related acute lung injury incidence and possibly mortality. There was no evidence that the effect differs across patient subgroups, but power to detect such differences was low.
authors.affiliation: 1Multidisciplinary Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C.), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. 2Harvard School of Public Health, Boston, MA. 3University Witten-Herdecke, Witten, Germany. 4Cliniques Universitaires Saint-Luc, Universite' Catholique de Louvain, Bruxelles, Belgium. 5School of Public Health, Imperial College, London, United Kingdom. 6Division of Neurosurgery, Dalhousie University, Halifax, Canada. 7Division of Preventive Medicine, Mayo Clinic, Rochester, MN. 8Department of Laboratory Medicine, University of California at San Francisco, San Francisco, CA.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Schmickl
authors.forename: Stefano
authors.initials: S
authors.lastname: Mastrobuoni
authors.forename: Filippos T
authors.initials: FT
authors.lastname: Filippidis
authors.forename: Suchita
authors.initials: S
authors.lastname: Shah
authors.forename: Julia
authors.initials: J
authors.lastname: Radic
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
authors.forename: Pearl
authors.initials: P
authors.lastname: Toy
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016913:Blood Component Transfusion / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D008297:Male; D010949:Plasma; D012737:Sex Factors