From the Department of Immunohematology and Blood Bank, Leiden University
Medical Centre (L.M.G.v.d.W., J.G.A.H., A.B., M.S.H.); Red Cross Blood Bank
Leidsenhage, Leiden, The Netherlands (L.M.G.v.d.W., A.B.); the Department of
Medical Statistics, Leiden University (J.H.); the Department of Infectious
Diseases, Leiden University Medical Centre, The Netherlands (P.J.v.d.B.); the
Department of Cardiothoracic Surgery, Leiden University Medical Centre, The
Netherlands (H.B., H.A.H.); and the Department of Anaesthesiology, Leiden
University Medical Centre, The Netherlands (F.B.).
Correspondence to Dr A. Brand, Blood Bank Leidsenhage, Albinusdreef 2, Bldg 1, E4-67, PO Box 2184, 2301 CD Leiden, Netherlands. E-mail lvdwat{at}stad.dsl.nl
Background—Leukocytes in transfused blood are associated with
several posttransfusion immunomodulatory effects. Although leukocytes
play an important role in reperfusion injury, the contribution of
leukocytes in transfused blood products has not been investigated.
To estimate the role and the timing of leukocyte filtration of red
cells in cardiac surgery, we performed a randomized study.
Methods and Results—Patients scheduled for cardiac surgery
were randomly allocated to receive either packed cells without buffy
coat (PC, n=306), fresh-filtered units (FF, n=305), or stored-filtered
units (SF, n=303) when transfusion was indicated. We evaluated the
periods of hospitalization and stay at the intensive care unit, and the
occurrences of postoperative complications up to 60 days after surgery.
The average hospital stay was 10.7 days, of which 3.2 days were in the
intensive care unit, without significant differences between the
groups. In the PC trial arm, 23.0% of the patients had infections
versus 16.9% and 17.9% of the patients in the leukocyte-depleted
trial arms (P=.13). Within 60 days, 45 patients had died, 24
patients in the PC trial arm (7.8%), versus 11 (3.6%) and 10 (3.3%)
patients in the FF and SF trial arms, respectively
(P=.015).
Conclusions—In cardiac surgery patients, especially when
more than three blood transfusions are required, leukocyte depletion by
filtration results in a significant reduction of the postoperative
mortality that can only partially be explained by the higher incidence
of postoperative infections in the PC group.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Beneficial Effects of Leukocyte Depletion of Transfused Blood on Postoperative Complications in Patients Undergoing Cardiac Surgery
A Randomized Clinical Trial
Key Words: leukocytes • blood • surgery • mortality • coronary disease
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