Canadian Journal of Anesthesia

, Volume 51, Issue 5, pp 417–424 | Cite as

Transfusion of leukoreduced red blood cells may decrease postoperative infections: two meta-analyses of randomized controlled trials

  • Dean Fergusson
  • Madhu Priya Khanna
  • Alan Tinmouth
  • Paul C. Hébert
General Anesthesia

Abstract

Purpose

To evaluate the efficacy and effectiveness of red blood cell leukoreduction in reducing postoperative infection, mortality and cancer recurrence, two meta-analyses of randomized controlled trials (RCTs) were conducted.

Methods

A systematic search of the scientific literature was conducted. The pooled relative risk ratio (RR) of developing an adverse postoperative outcome with either leukoreduced or non-leukoreduced blood was calculated using a random effects model. To better estimate the efficacy of leukoreduction, a second analysis of transfused patients only was conducted.

Results

Ten RCTs met inclusion criteria and eight provided separate data for patients randomized and transfused. The mean percentage of patients randomized but not transfused was 34%. For postoperative infection, the overall pooled RR was 0.76 [(95% confidence interval (CI): 0.54–1.08] for the “all patients randomized” analysis. For the “only patients transfused” analysis, the pooled RR became clinically and statistically significant (RR = 0.60 (95% CI: 0.38–0.93). For mortality, the pooled RR for the “all patients randomized” analysis was 0.71 (95% CI: 0.45–1.13) and 0.61 (95% CI: 0.36–1.04) for the “only patients transfused” analysis. When analyzing either all patients randomized or all patients transfused, there was no statistically significant difference in cancer recurrence rates (one study only).

Conclusion

We demonstrated that patients who were transfused leukoreduced red blood cells might benefit from a decrease in postoperative infections. A decrease in mortality may have been realized if more patients had been enrolled in the various randomized trials. Including all patients randomized, regardless of whether or not they were actually transfused diluted the observed clinical benefit of leukoreduction.

La transfusion de sang réduit en leucocytes peut diminuer les infections postopératoires : deux méta-analyses d’études randomisées et contrôlées

Résumé

Objectif

Dans le but d’évaluer l’efficacité de la réduction leucocytaire à diminuer l’infection postopératoire, la mortalité et la récurrence du cancer, nous avons réalisé deux méta-analyses d’études randomisées et contrôlées (ERC).

Méthode

Une recherche systématique des publications scientifiques a été réalisée. Le risque relatif (RR) de subir des complications postopératoires avec du sang réduit ou non en leucocytes a été calculé au moyen d’un modèle à effets aléatoires. Afin de mieux estimer l’efficacité de la réduction leucocytaire, une seconde analyse des patients transfusés a été faite.

Résultats

Dix ERC répondaient aux critères d’inclusion et huit portaient sur des patients randomisés et transfusés. Le pourcentage moyen de patients randomisés mais non transfusés était de 34 %. Le RR global d’une infection postopératoire était de 0,76 [(intervalle de confiance de 95 % (IC) : 0,54–1,08] pour l’analyse où «tous les patients sont randomisés». Dans l’analyse des «seuls patients transfusés», le RR est devenu cliniquement et statistiquement significatif (RR = 0,60 (IC de 95 % : 0,38–0,93). Le RR de mortalité dans l’analyse de «tous les patients randomisés» était de 0,71 (IC 95 % : 0,45–1,13) et de 0,61 (IC 95 % : 0,36–1,04) dans l’analyse des «seuls patients transfusés». Les analyses de tous les patients randomisés et de tous les patients transfusés n’ont pas montré de différence statistiquement significative de récurrence du cancer (une étude seulement).

Conclusion

Les patients qui reçoivent du sang réduit en leucocytes sont moins susceptibles d’avoir des infections postopératoires. Une baisse de la mortalité aurait pu être réalisée si plus de patients avaient participé aux diverses études randomisées. Quand on inclut tous les patients randomisés, peu importe qu’ils aient été transfusés ou non, on observe une dilution des avantages cliniques de la réduction leucocytaire.

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Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  • Dean Fergusson
    • 1
    • 2
  • Madhu Priya Khanna
    • 2
  • Alan Tinmouth
    • 1
    • 2
  • Paul C. Hébert
    • 1
    • 2
  1. 1.Clinical Epidemiology ProgramOttawa Health Research InstituteOttawaCanada
  2. 2.University of Ottawa Centre for Transfusion ResearchOttawa HospitalOttawaCanada

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