Abstract
Objective: Correlations and risk factors remain to be unclarified for post-heart-surgery posttransfusion graft-versus-host disease, mediastinitis, and late cardiac tamponade caused by deteriorated host-defense mechanisms due to cardiopulmonary bypass both with and without steroid usage.Methods: We sent questionnaires to 298 Japanese cardiovascular institutions asking for institution profiles, including infection control, steroid use in cardiopulmonary bypass, and prevalence of mediastinitis, late cardiac tamponade, and posttransfusion graft-versus-host disease during 1994. The overall prevalence of posttransfusion graft-versus-host disease since the start of service (from establishment of institution to date) was also requested.Results: The number of pump cases at the 119 institutions responding (40%) were 91.6±67.9 cases/institution (total = 10,904). The prevalence of mediastinitis was 1.2±1.8 and that of late cardiac tamponade 1.0±1.8%. Posttransfusion graft-versus-host disease occurred in 1 of 10,904 patients (0.01%) during 1994 at an institution where steroids and nonirradiated blood were used in surgery. The simple institutional mean prevalence of posttransfusion graft-versus-host disease since establishing institutions was 0.08±0.13%. Of the 119 institutions surveyed, 86 used steroids in all pump cases (72%); 11 institutions used steroids in a limited number of cases (9%). The institutional mean of methylprednisolone-converted steroid dose was 21.5±16.4 mg/kg (n = 119). In multivariate regression analysis, operation time (p=0.005) for mediastinitis, steroid usage (all, limited, or no cases) (p=0.01) and %aneurysm (p=0.05) for late cardiac tamponade, and steroid dosage (p=0.002) for posttransfusion graft-versus-host disease were identified as significant risk factors.Conclusion: Our results suggest that massive steroid administration for cardiopulmonary bypass may increase the risk of posttransfusion graft-versus-host disease and late cardiac tamponade, but not mediastinitis.
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Mayumi, H., Nakashima, A., Nishimi, M. et al. Risk factors for posttransfusion graft versus host disease, mediastinitis, and late cardiac tamponade in heart surgery. Jpn J Thorac Caridovasc Surg 48, 47–55 (2000). https://doi.org/10.1007/BF03218084
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DOI: https://doi.org/10.1007/BF03218084