L. M. G. van de Watering

Double-Blind, Randomized Controlled Trial on the Effect of Leukocyte-Depleted Erythrocyte Transfusions in Cardiac Valve Surgery

Background—Leukocytes in allogeneic blood transfusions are believed to be the cause of immunomodulatory events. A few trials on leukocyte removal from transfusions in cardiac surgery have been conducted, and they showed inconclusive results. We found in a previous study a decrease in mortality rates and number of infections in a subgroup of more heavily transfused patients. Methods and Results—Patients (n= 496) undergoing valve surgery (with or without CABG) were randomly assigned in a double-blind fashion to receive standard buffy coat–depleted (PC) or prestorage, by filtration, leukocyte-depleted erythrocytes (LD). The primary end point was mortality at 90 days, and secondary end points were in-hospital mortality, multiple organ dysfunction syndrome, infections, intensive care unit stay, and hospital stay. The difference in mortality at 90 days was not significant (PC 12.7% versus LD 8.4%; odds ratio [OR], 1.52; 95% confidence interval [CI], 0.84 to 2.73). The in-hospital mortality rate was almost twice as high in the PC group (10.1% versus 5.5% in the LD group; OR, 1.99; 95% CI, 0.99 to 4.00). The incidence of multiple organ dysfunction syndrome in both groups was similar, although more patients with multiple organ dysfunction syndrome died in the PC group. LD was associated with a significantly reduced infection rate (PC 31.6% versus LD 21.6%; OR, 1.64; 95% CI, 1.08 to 2.49). In both groups, intensive care unit stay and hospital stay were similar, and postoperative complications increased with the number of transfused units. Conclusions—Mortality at 90 days was not significantly different; however, a beneficial effect of LD in valve surgery was found for the secondary end points of in-hospital mortality and infections.

Prevalence and specificities of red blood cell alloantibodies in transfused Ugandans with different diseases

Background and Objectives  Alloantibody formation against red blood cell (RBC) antigens is a common complication of transfusion therapy. However, the prevalence of RBC alloimmunization is hardly known in Black Africans. In Uganda, the practice is to transfuse ABO/D compatible blood without screening for immune antibodies. The aim of this study was to determine the prevalence and specificities of RBC alloantibodies in transfused Ugandans.

Leucocyte depletion of perioperative blood transfusion does not affect long-term survival and recurrence in patients with gastrointestinal cancer.

Perioperative red blood cell (RBC) transfusion may be associated with a poor prognosis in cancer surgery. Allogeneic leucocytes are assumed to play a causal role. This study evaluated the long‐term effect of transfusion with leucocyte‐depleted (LD) blood in patients with gastrointestinal cancer.

Cost-effectiveness of leucocyte depletion of red-cell transfusions for patients undergoing cardiac surgery

1 Groningen University Institute for Drug Exploration/University of Groningen Institute of Pharmacy (GUIDE/GRIP), Groningen, the Netherlands 2 Department of Immunohematology and Blood Bank, Leiden University Medical Centre, Leiden, the Netherlands 3 Martini Hospital, Department of Clinical Pharmacy and Toxicology, Groningen, the Netherlands 4 Sanquin Blood Supply Foundation, Amsterdam, the Netherlands

The effect of RBC transfusions on cytokine gene expression after cardiac surgery in patients developing post‐operative multiple organ failure

Aim: To determine the effect of red blood cell (RBC) transfusions during cardiac surgery on cytokine gene expression (GE) in relation to multiple organ failure (MOF) development after systemic inflammatory response syndrome (SIRS).

HS2 COST-EFFECTIVENESS OF LEUKODEPLETION IN MAJOR CARDIAC SURGERY

rials, labour and surgical procedures) and are dependent on TTH. RESULTS: After 18,000 iterations the average TTH (cost) fell from 25.9 (€2136) to 22.0 weeks (€1987) for small ulcers (<10cm) and from 39.0 (€7047) to 33.0 weeks (€6362) for large ulcers (>=10cm) when UK-970005 Device was added. Corresponding coefficients of variation ranged between 99% and 125% for TTH and 86% and 120% for costs. The main cost driver was labour costs (75% and 84% for small and large ulcers, respectively). The remaining costs were split equally on materials and surgical procedures. Break-even was reached at a relative efficacy of UK-97-0005 Device of 7%. On the basis of an average prevalence of VLU of 0.2% in Sweden, the total cost of treating VLU-patients with UK-97-0005 Device was estimated to €59.7 million. CONCLUSION: At a relative efficacy above 7%, UK-970005 Device was shown to be a dominant alternative compared to conventional treatment of VLU in Sweden.

Blood Transfusion and Cancer: Modulation or Tolerance?

The concept of immunosurveillance has evoked a wide spread interest in the role of the immune system in the natural history of cancer. Clinical data from immunodeficient [1] and immunosuppressed [2] patients show an increased incidence of malignancy. Blood transfusions (BT) have diverse immunomodulating effects. For instance, pre-transplant random-donor BT diminish the incidence of renal allograft rejection [3,4] and can give rise to leukocyte antibodies [5]. Several essential factors and clues for the mechanisms of this BT induced immunosuppression in allograft transplantation have recently been elucidated, but the precise mechanism(s) remains unclear. Combining these observed phenomena Gantt raised the question whether immunomodulating effects of peri-operative blood transfusion might adversely affect the prognosis of cancer patients [6]. Surgical resection of tumours often requires blood transfusion. In case of a curative operation, the primary tumour is removed, but nevertheless a percentage of the patients will develop distant metastases [7]. Minimal residual disease in the form of undetectable micrometastases and/or tumour cells spilled in the operation region or into the circulation during surgery might be explanations for these observations. However, not all patients having a similar cancer stage show recurrence of the tumour. Probably minimal residual disease not always results in cancer recurrence. It is suggested that besides tumour characteristics and genetics the immune defense might play a role in the outgrowth of micrometastases. Before addressing possible mechanisms the relationship between blood transfusion and cancer prognosis has to be clarified on a clinical level (the horizontal arrow in (Figure 1).