title: Effect of Blood Donor Characteristics on Transfusion Outcomes: A Systematic Review and Meta-Analysis.
abstract: Optimal selection of blood donors is critical for ensuring the safety of blood products. The current selection process is concerned principally with the safety of the blood donor at the time of donation and of the recipient at the time of transfusion. Recent evidence suggests that the characteristics of the donor may affect short- and long-term transfusion outcomes for the transfused recipient. We conducted a systematic review with the primary objective of assessing the association between blood donor characteristics and red blood cell (RBC) transfusion outcomes. We searched MEDLINE, EMBASE, and Cochrane Central databases and performed manual searches of top transfusion journals for all available prospective and retrospective studies. We described study characteristics, methodological quality, and risk of bias and provided study-level effect estimates and, when appropriate, pooled estimates with 95% confidence intervals using the Mantel-Haenszel or inverse variance approach. The overall quality of the evidence was graded using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. From 6121 citations identified by our literature search, 59 studies met our eligibility criteria (50 observational, 9 interventional). We identified the evaluation of association of 17 donor characteristics on RBC transfusion outcome. The risk of bias and confounding of the included studies was high. The quality of evidence was graded as very low to low for all 17 donor characteristics. Potential associations were observed for donor sex with reduced survival at 90 days and 6 months in male recipients that receive donated blood from females (hazard ratio 2.60 [1.09, 6.20] and hazard ratio 2.40 [1.10, 5.24], respectively; n = 1), Human Leukocyte Antigen - antigen D Related (HLA-DR) selected transfusions (odds ratio [OR] 0.39 [0.15, 0.99] for the risk of transplant alloimmunization, n = 9), presence of antileukocyte antibodies (OR 5.84 [1.66, 20.59] for risk of transfusion-related acute lung injury, n = 4), and donor RBC antigens selection (OR 0.20 [0.08, 0.52] for risk of alloimmunization, n = 4). Based on poor quality evidence, positive antileukocyte antibodies, female donor to male recipients, HLA-DR selected RBC transfusion, or donor RBC antigen selection may affect RBC transfusion outcome. Our findings that donor characteristics may be associated with transfusion outcomes warrant establishing vein-to-vein data infrastructure to allow for large robust evaluations. PROSPERO registration number: CRD42013006726.
authors.affiliation: Clinical Epidemiology program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Michaël
authors.initials: M
authors.lastname: Chassé
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Lauralyn
authors.initials: L
authors.lastname: McIntyre
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Shane W
authors.initials: SW
authors.lastname: English
authors.affiliation: Clinical Epidemiology Program, Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Tinmouth
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Greg
authors.initials: G
authors.lastname: Knoll
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Dianna
authors.initials: D
authors.lastname: Wolfe
authors.affiliation: Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Canada.
authors.forename: Kumanan
authors.initials: K
authors.lastname: Wilson
authors.affiliation: Mount Sinai Hospital, Toronto, Canada.
authors.forename: Nadine
authors.initials: N
authors.lastname: Shehata
authors.affiliation: Ottawa Hospital, Civic Campus, Ottawa, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Forster
authors.affiliation: Clinical Epidemiology Program, Box 201B, Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Carl
authors.initials: C
authors.lastname: van Walraven
authors.affiliation: Clinical Epidemiology Program, Box 201B, Ottawa Hospital Research Institute, Ottawa, ON, Canada. Electronic address: dafergusson@ohri.ca.
authors.forename: Dean A
authors.initials: DA
authors.lastname: Fergusson
mesh_terms: D000367:Age Factors; D015982:Bias; D001782:Blood Donors / Q000706:statistics & numerical data; D046148:Donor Selection; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005260:Female; D006680:HLA Antigens / Q000032:analysis; D017052:Hospital Mortality; D006801:Humans; D007518:Isoantibodies / Q000276:immunology; D008297:Male; D064887:Observational Studies as Topic; D012107:Research Design; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014766:Viremia / Q000635:transmission
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies
keywords: Blood donors; Outcomes; Red blood cells; Systematic review; Transfusion