The relationship of plasma transfusion from female and male donors with outcome after cardiac surgery
Received 12 May 2009; received in revised form 16 September 2009; accepted 20 December 2009. published online 08 February 2010. Corrected Proof
Objective
Pulmonary dysfunction is common in transfused patients recovering from heart surgery. Plasma transfusion from female donors has been linked with rare catastrophic lung injury, but its relationship with outcome after cardiac surgery is poorly understood. We examined whether plasma donor gender is related to postcardiac surgery pulmonary dysfunction and death or prolonged hospitalization.
Methods
In this retrospective case-control study, cardiac surgery candidates who received plasma perioperatively from only female donors were compared with male-only recipients who were matched for the number of units transfused and surgery date.
Results
In a dataset of 2157 recipients, there were no blood bank–reported complications, but escalating plasma transfusion was associated with increased 30-day mortality (odds ratio, 1.52 per unit; P = .0001). From the 1069 recipients receiving plasma exclusively from female or male donors, 390 matched pairs were identified. Recipients of female compared with male donor plasma had a lower incidence of pulmonary dysfunction (5.9% vs 10.8%; P = .01) and death or hospitalization more than 10 days (9% vs 16.4%; P = .002) but similar long-term survivals.
Conclusion
Escalating plasma transfusion was associated with 30-day mortality, but female donor plasma recipients had less pulmonary dysfunction and fewer poor outcomes compared with male-only recipients. Although our retrospective study findings neither support nor refute a strategic policy to exclude female donor plasma to reduce catastrophic transfusion-related acute lung injury, they raise concern that such a policy may have unanticipated effects on outcome in patients undergoing cardiac surgery and highlight a need for additional studies in this and other patient groups.
aDepartment of Anesthesiology, Duke University Medical Center, Durham, North Carolina
bDepartment of Pathology, University of Alabama, Birmingham, Alabama
cCarolinas Region American Red Cross, Charlotte, North Carolina
dPerioperative Services, Duke University Medical Center, Durham, North Carolina
eTransfusion Medicine, Duke University Medical Center, Durham, North Carolina
fCardiothoracic Anesthesiology Research Endeavors, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (see Appendix 2).
Address for reprints: Mark Stafford-Smith, MD, Department of Anesthesiology, Duke University Medical Center, Box 3094 DUMC, Durham, NC 27710.
For members of Cardiothoracic Anesthesiology Research Endeavors, See Appendix 2.
ABSTRACT