Introduction of universal prestorage leukodepletion of blood components, and outcomes in transfused cardiac surgery patients.
OBJECTIVE
To assess whether introduction of universal leukodepletion (ULD) of red blood cells (RBCs) for transfusion was associated with improvements in cardiac surgery patient outcomes.


METHODS
Retrospective study (2005-2010) conducted at 6 institutions. Associations between leukodepletion and outcomes of mortality, infection, and acute kidney injury (AKI) were modeled by logistic regression, and intensive care unit length of stay (LOS) in survivors was explored using linear regression. To examine trends over time, odds ratios (ORs) for outcomes of transfused were compared with nontransfused patients, including a comparison with nontransfused patients who were selected based on propensity score for RBC transfusion.


RESULTS
We studied 14,980 patients, of whom 8857 (59%) had surgery pre-ULD. Transfusions of RBCs were made in 3799 (43%) pre-ULD, and 2525 (41%) post-ULD. Administration of exclusively leukodepleted, versus exclusively nonleukodepleted, RBCs was associated with lower incidence of AKI (adjusted OR 0.80, 95% confidence interval [CI] 0.65-0.98, P = .035), but no difference in mortality or infection. For post-ULD patients, no difference was found in mortality (OR 0.96, 95% CI 0.76-1.22, P = .76) or infection (OR 0.91, 95% CI 0.79-1.03, P = .161); however, AKI was reduced (OR 0.79 95% CI 0.68-0.92, P = .003). However, ORs for post-ULD outcomes were not significantly different in nontransfused, versus transfused, patients. Furthermore, those who received exclusively nonleukodepleted RBCs were more likely to have surgery post-ULD.


CONCLUSIONS
Universal leukodepletion was not associated with reduced mortality or infection in transfused cardiac surgery patients. An association was found between ULD and reduced AKI; however, this reduction was not significantly different from that seen in nontransfused patients, and other changes in care most likely explain such changes in renal outcomes.
Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; The Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Research and Development, Australian Red Cross Blood Service, Melbourne, Victoria, Australia; Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia. Electronic address: zoe.mcquilten@monash.edu.
Zoe K
ZK
McQuilten
Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Nick
N
Andrianopoulos
Sanquin-LUMC (Leiden University Medical Centre), Center for Clinical Transfusion Research, Leiden, The Netherlands.
Leo
L
van de Watering
The Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Cecile
C
Aubron
Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Louise
L
Phillips
The Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Intensive Care Unit, Austin Hospital, Melbourne, Victoria, Australia.
Rinaldo
R
Bellomo
The Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia.
David
D
Pilcher
Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Peter
P
Cameron
Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Christopher M
CM
Reid
Research and Development, Australian Red Cross Blood Service, Melbourne, Victoria, Australia.
Merrole F
MF
Cole-Sinclair
University of Melbourne Department of Surgery (Cardiothoracic Surgery), St Vincent's Hospital, Melbourne, Victoria, Australia.
Andrew
A
Newcomb
Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia; Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Victoria, Australia.
Julian
J
Smith
Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
John J
JJ
McNeil
Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Erica M
EM
Wood
D000368:Aged; D006348:Cardiac Surgical Procedures; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D047589:Leukocyte Reduction Procedures; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
Leukocyte reduction procedures; coronary artery bypass; erythrocyte transfusion