title: Transfusion of sex-mismatched and non-leukocyte-depleted red blood cells in cardiac surgery increases mortality.
abstract: OBJECTIVE
  To examine the mortality risk of blood transfusions when donor information, postdonation treatment, and a wide selection of risk factors are taken into account.
  
  
  METHODS
  A retrospective study was performed on 9907 patients who underwent coronary artery bypass grafting and/or aortic valve replacement. Several transfusion-related risk factors, including age of blood products, sex of donor, ABO group, Rh group, posttransfusion treatment, and sex matching, were included in the analysis. A wide selection of preoperative comorbidities were included as well. A Cox proportional hazards analysis was performed to determine significant risk factors. Patients were followed for a period of up to 12 years posttransfusion.
  
  
  RESULTS
  We found an excess mortality for transfusions of sex-mismatched red blood cells (RBCs) per unit transfused (hazard ratio [HR], 1.083; 95% confidence interval [CI] 1.028-1.140; P = .003). In addition, we found a significant risk during the first year for transfusing 1 to 2 units of non-leukocyte-depleted RBCs (HR, 1.426; 95% CI, 1.004-2.024; P = .047). Transfusion of 1 to 2 units of leukocyte-depleted RBCs was not associated with increased risk (HR, 0.981; 95% CI, 0.866-1.110; P = not significant). The age of blood products was not associated with increased mortality.
  
  
  CONCLUSIONS
  In this large retrospective study, transfusion of non-sex-matched RBCs was associated with increased mortality. In addition, in patients receiving small amounts of blood, leukocyte depletion of RBCs had a beneficial effect on patient survival.
authors.affiliation: Department of Cardiothoracic Surgery, Clinical Sciences, Lund University, Lund, Sweden. Electronic address: henrik.bjursten@med.lu.se.
authors.forename: Henrik
authors.initials: H
authors.lastname: Bjursten
authors.affiliation: Department of Anesthesiology and Intensive Care, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Alain
authors.initials: A
authors.lastname: Dardashti
authors.affiliation: Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Björk
authors.affiliation: Department of Cardiothoracic Surgery, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Wierup
authors.affiliation: Department of Anesthesiology and Intensive Care, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Algotsson
authors.affiliation: Department of Anesthesiology and Intensive Care, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Ederoth
mesh_terms: D000017:ABO Blood-Group System; D000368:Aged; D001782:Blood Donors; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D004906:Erythrocyte Count; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D065227:Transfusion Reaction
chemical_list: D000017:ABO Blood-Group System
keywords: CABG; sex mismatch; survival; transfusion