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9. Pre-storage Leukoreduction Of Transfused Packed Red Blood Cells Improves Mid-term Survival Following Cardiac Surgery
Anthony P Furnary, Yingxing Wu, Hugh L Gately, Jeffrey S Swanson, Pasala Ravichandran, Grace Chien, Cynthia D Morris, Lynn K Boshkov, Gary L Grunkemeirer, H. Storm Floten; Portland, OR
Objective: Transfusion of packed red blood cells (PRBC) is associated with higher operative mortality and diminished long-term survival following cardiac surgery when compared to non-transfused patient outcomes. This prospective, randomized, double-blind, multi-center trial was designed to determine if pre-storage leukoreduction (LR) of transfused PRBC would improve survival in transfused cardiac surgery patients, as compared to those receiving standard PRBC (sPRBC).
Methods: 1226 adult patients from 3 centers, scheduled for cardiac surgery utilizing cardiopulmonary bypass, were preoperatively randomized to receive either LR or sPRBC if transfusion was deemed necessary during or following operation. Patients who were preoperatively transfused within 90 days of operation were excluded from participation. All patients and health care personnel with direct patient contact were blinded to treatment group.
Results: 562 (45.8%) patients were transfused: 304 LR and 258 sPRBC. Randomization produced clinically equivalent groups. Thirty-day operative mortality was not significantly affected. Mortality at 60 and 90 days was significantly better in the LR group. Kaplan-Meier (KM) analysis revealed a mid-term survival benefit for LR that persists for at least 12 months. Mortality for non-transfused patients was significantly lower than either LR or sPRBC at all time points (p< 0.0001). LR had the effect of reducing time-related mortality of sPRBC transfused patients by 50% as compared to non-transfused patients.
Conclusions: In cardiac surgery patients who require transfusions, LR transfusions improve mid-term survival as compared to those transfused with sPRBC. This effect may be due to the pro-inflammitory effects of sPRBC which are eliminated by prestorage leukoreduction. LR does not affect operative mortality. LR should be used for all open-heart surgery patients who require transfusion.
Mortality: LR vs. sPRBC
| Mortality: |
Operative (n) |
2-month (n) |
3-month (n) |
6-month (n) |
9-month (KM) |
1 year (KM) |
| LR |
4.9% (15) |
4.9% (15) |
5.3% (16) |
5.9% |
7.0% |
7.0% |
| sPRBC |
7.0% (18) |
9.7% (25) |
9.7% (25) |
10.1% |
11.3% |
11.7% |
| p-value |
0.305 |
0.029 |
0.044 |
0.07 |
0.025 |
0.053 |
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