Leukocyte filtration and postoperative infections

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• 作者：Seunghyug Kwon ; BS ; MPH^a ; Sungyub Lew ; MD^a ; ^b ; Ronald S. Chamberlain ; MD ; MPA ; FACS^a ; ^b ; ^c ; ^{rchamberlain@barnabashealth.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Leukocyte filtration ; Postoperative infections ; Transfusion ; Transfusion-related immunomodulation ; White-blood-cell reduction ; Meta-analysis
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：205
• 期：2
• 页码：499-509
• 全文大小：1600 K

文摘

Leukocyte filtration has been hypothesized to reduce the risk of postoperative infections by alleviating the immunosuppressive effect of whole blood. However, the literature regarding the clinical efficacy of leukocyte filtration remains conflicted. This meta-analysis investigates the impact of allogeneic and autologous leukocyte-filtered blood transfusions on the incidence of postoperative infections in adult surgical patients.

Methods

A comprehensive literature search of PubMed, Google Scholar, and Cochrane Central Registry of Controlled trials (1966-2016) was completed for all published randomized controlled trials. Postoperative infections under “as-per-protocol” (APP) and “intention-to-treat” (ITT), length of stay, and mortality were analyzed.

Results

Sixteen randomized controlled trials involving 6586 randomized (ITT) patients (4615 APP patients) in various clinical settings were evaluated. The leukocyte-filtered blood group demonstrated an overall 26% risk reduction in postoperative infections when analyzed by APP (relative risk [RR] = 0.74; 95% confidence interval [CI, 0.60-0.92]; P = 0.007) and a 22% risk reduction when analyzed by ITT (RR = 0.78; 95% CI [0.65-0.94]; P = 0.009). Leukocyte-filtered blood was also associated with a significant reduction in length of stay (standardized difference of mean [SDM] = −0.74; 95% CI [−1.32 to −0.15]; P = 0.014) and all-cause mortality (RR = 0.74; 95% CI [0.57-0.95]; P = 0.018).

Conclusions

Leukocyte-filtered blood transfusions are associated with significantly lower postoperative infection rates in both the APP and ITT populations. Leukocyte filtration also shortens length of stay and decreases all-cause mortality in surgical patients and should be considered in all surgical patients.