Usefulness of autologous blood transfusion for avoiding allogenic transfusion and infectious complications after esophageal cancer resection

lncRNA MALAT1 Accelerates Wound Healing of Diabetic Mice Transfused with Modified Autologous Blood via the HIF-1α Signaling Pathway

Impaired wound healing is a debilitating complication of diabetes. The long non-coding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) has been recognized to be differentially expressed in various diseases. However, its underlying mechanism in diabetes has not been fully understood. Notably, we aim to examine the expression of MALAT1 in diabetic mice and its role in wound healing involving the hypoxia-inducible factor-1α (HIF-1α) signaling pathway with a modified autologous blood preservative solution reported. A mouse model of diabetes was established. MALAT1 was identified to promote the activation of the HIF-1α signaling pathway and to be enriched in autologous blood through modified preservation, which might facilitate the improvement of physiological function of blood cells. Through gain- or loss-of-function approaches, viability of fibroblasts cultured in high glucose, wound healing of mice, and collagen expression in wound areas were enhanced by MALAT1 and HIF-1α. Taken together, the present study demonstrated that the physiological status of mouse blood was effectively improved by modified autologous blood preservation, which exhibited upregulated MALAT1, thereby accelerating the fibroblast activation and wound healing in diabetic mice via the activation of the HIF-1α signaling pathway. The upregulation of MALAT1 activating the HIF-1α signaling pathway provides a novel insight into drug targets against diabetes.

Comparison between autologous and homologous blood transfusions in liver resection for biliary tract cancer: a propensity score matching analysis

BACKGROUND

It remains unclear whether preoperative blood donation is truly beneficial in liver surgery. The aim of this study was to compare surgical outcomes between patients receiving autologous and homologous transfusions during liver resection for biliary tract cancer (BTC).

METHODS

Patients who underwent hepatectomy for BTC were retrospectively reviewed (2006-2017). Patients who deposited autologous blood and underwent resection without homologous blood transfusion intraoperatively (Autologous group) were compared with non-depositing patients who required homologous transfusion during hepatectomy (Homologous group). Propensity score matching analyses were performed to adjust the data for the baseline characteristics of both groups.

RESULTS

During the study period, 359 patients were included in the Autologous group, and 105 patients were in the Homologous group. The postoperative maximum total bilirubin (T-Bil) levels and the incidence of postoperative liver failure were significantly higher in the Homologous group than in the Autologous group. After propensity score matching, postoperative maximum T-Bil levels were significantly higher in the Homologous group, whereas the incidence of postoperative liver failure was comparable between the two groups; between-group differences were not observed for the remaining major complications, hospital stays and mortality.

CONCLUSION

Although autologous blood transfusion may minimize postoperative hyperbilirubinemia, it may not decrease the risk for mortality or morbidities following hepatectomy for BTC.

Allogenic Blood Transfusion is Associated with Poor Perioperative and Long-Term Outcome in Esophageal Cancer

BACKGROUND

Esophageal resection for cancer (EC) is still associated with considerable mortality and morbidity rates. Allogenic blood transfusion (aBT) is associated with poor short-term and long-term outcome in surgical oncology. We aimed to evaluate the effect of aBT in a homogeneous population of EC patients undergoing esophagectomy without perioperative treatment.

METHODS

We analyzed 565 esophagectomies performed due to EC. Allogenic blood transfusion was correlated to clinicopathological parameters, perioperative mortality and morbidity as well as the long-term outcome. Results are presented as adjusted odds ratio (OR) or hazard ratio (HR) with 95 % confidence interval (95 % CI).

RESULTS

Patients receiving aBT (aBT(+)) had no higher tumor stages or higher rates of lymph node metastasis (P = 0.65 and 0.17, respectively) compared to patients without aBT (aBT(-)). Allogenic blood transfusion was strongly associated with perioperative morbidity (OR 1.9, 95 % CI 1.1-3.5, P = 0.02) and mortality (OR 2.9, 95 % CI 1.0-8.6, P = 0.04). Tumor recurrence rate was significantly higher in aBT(+) patients (P = 0.001). The disease-free and overall survival were significantly longer in aBT(-) compared to aBT(+) patients (P = 0.016 and <0.001, respectively). Patients receiving aBT had almost doubled risk for tumor recurrence (HR 1.8, 95 % CI 1.2-2.5, P = 0.001) and death (HR 2.2, 95 % CI 1.5-3.2, P < 0.001).

CONCLUSION

Allogenic blood transfusion has a significant impact on the natural course of EC after complete resection. The poor short-term and long-term outcome warrants further evaluation of the underlying molecular mechanisms induced by allogenic blood transfusion in cancer patients.

Intraoperative fluid administration is associated with perioperative outcomes in pancreaticoduodenectomy: a single center retrospective analysis

BACKGROUND

Recent studies on perioperative fluid administration in patients undergoing major abdominal surgery have suggested that increased fluid loads are associated with worse perioperative outcomes. However, results of retrospective analyses of the relationship between intraoperative fluid (IOF) administration and perioperative outcomes in patients undergoing pancreaticoduodenectomy (PD) are conflicted. We sought to investigate this relationship in patients undergoing PD at our academic center.

METHODS

A retrospective analysis of 124 patients undergoing PD from 2007 to 2012 was performed. IOF administration rate (ml/kg/hr) was correlated with perioperative outcomes. Outcomes were also stratified by preoperative serum albumin level.

RESULTS

Regression analyses were performed comparing independent perioperative variables, including IOF rate, to four outcomes variables: length of stay, severity of complications, number of complications per patient, and 30-day mortality. Both univariate and multivariate regression analyses showed IOF rate correlated with one or more perioperative outcomes. Patients with an albumin ≤ 3.0 g/dl who received more than the median IOF rate experienced more severe complications, while patients with an albumin >3.0 g/dl did not.

CONCLUSION

Increased IOF administration is associated with worse perioperative outcomes in patients undergoing PD. Patients with low preoperative serum albumin levels (≤ 3.0 g/dl) may be a group particularly sensitive to volume overload.

Effect of perioperative blood transfusion on clinical outcomes in hepatic surgery for cancer

Allogeneic blood transfusion during liver resection for malignancies has been associated with an increased incidence of different types of complications: infectious complications, tumor recurrence, decreased survival. Even if there is clear evidence of transfusion-induced immunosuppression, it is difficult to demonstrate that transfusion is the only determinant factor that decisively affects the outcome. In any case there are several motivations to reduce the practice of blood transfusion. The advantages and drawbacks of different transfusion alternatives are reviewed here, emphasizing that surgeons and anesthetists who practice in centers with a high volume of liver resections, should be familiar with all the possible alternatives.

Predeposit autologous plasma donation in liver resection for hepatocellular carcinoma: toward allogenic blood-free operations

BACKGROUND

The aim of this study was to evaluate the safety of predeposit autologous plasma donation (PAPD) and its efficacy in avoiding allogenic blood transfusions and albumin infusion in liver resection for hepatocellular carcinoma.

STUDY DESIGN

PAPD was adopted in 20 patients in whom liver function remained within Child-Pugh's class A and an indocyanine green retention rate at 15 minutes was < or = 15% (PAPD group). Up to 1,200 mL of autologous fresh frozen plasma was collected through three blood donation sessions. Allogenic blood transfusion rates, albumin infusion rates, and postoperative courses were compared between the PAPD group and a historic control (no PAPD) group (n = 36).

RESULTS

Serum albumin levels after the last blood donation session were not significantly different from those before PAPD. The prothrombin activity even increased through the blood donation sessions (from median 80.9% [range 70.0% to 100%] to median 89.2% [range 71.2% to 100%]; p < 0.001). Allogenic blood transfusion rate and albumin infusion rate were lower in the PAPD group than in the no PAPD group (11% versus 75%; p < 0.001 and 16% versus 47%; p = 0.038, respectively). Wastage rate of the autologous fresh frozen plasma products was 9%.

CONCLUSIONS

PAPD was safe in patients with underlying liver disease and can be beneficial in simulating the liver synthetic function in advance of operation. Autologous fresh frozen plasma transfusion was effective for avoiding allogenic blood products in liver resection for hepatocellular carcinoma.

Is harmonic scalpel an effective tool for oesophagectomy?

INTRODUCTION

Use of electrocautery in oesophagectomy is standard; however, the introduction of the harmonic scalpel (HS) and its use has changed the methodology of oesophagectomy in recent years. We have assessed the efficiency of HS in oesophageal cancer surgery. The parameters studied were blood loss, transfusion rates, and postoperative complications.

METHODS

Our cohort included 142 patients who underwent elective oesophagectomy from January 1999 to December 2004. The control group was the patients undergoing electrocautery oesophagectomy (n=98) between 1999 and 2002. Furthermore, 44 patients who were operated with the HS were included in the study group.

RESULTS

The numbers of units transfused were significantly less in HS group (median 0) in comparison with controls (median 2), p=0.003. Median blood loss in HS and the controls was 500 and 700 ml respectively (p=0.123). Mortality in HS group was 2.27%compared to 3.06% in controls (p=0.14). The complication (principally respiratory) rate was only 13.6% of patients in HS group compared to 17.3% in the controls.

CONCLUSION

Our study shows that HS reduces transfusion rates and postoperative complications, highlighting it as a safe and effective alternative to traditional electrocautery.

Use of a leucocyte filter to remove tumour cells from intra-operative cell salvage blood

SUMMARY

The intra-operative blood loss of 50 consecutive gynae-oncology patients undergoing surgery for endometrial, cervical or ovarian cancer was cell salvaged and filtered. In each case blood samples were taken from the effluent tumour vein, a central venous line, the cell saver reservoir, the cell salvage re-transfusion bag after processing but before filtration and from the cell salvage re-transfusion bag after processing and filtration. Samples were examined using immunohistochemical monoclonal antibody markers for epithelial cell lines. Viable, nucleated malignant cells were detected in 2/50 central venous samples, 34/50 reservoir samples and 31/50 unfiltered cell salvaged samples. After passage through a Pall RS leucocyte depletion filter no remaining viable, nucleated malignant cells were detected in any sample. The clinical risks of cell salvage in these circumstances should be reviewed in the light of the risks of allogeneic blood transfusion.

Stellenwert der Anästhesie in multimodalen onkologischen Therapiekonzepten

Patients with malignant diseases are increasingly being treated with multimodal therapeutical concepts based on the three major modalities surgery, radiotherapy and chemotherapy. The perioperative period is crucial within this multimodal concept as the prognosis of patients may be directly influenced by perioperative measures. In addition, it is of major importance to avoid complications in the perioperative phase, as these might worsen the prognosis of the patient and in order to prevent a delay in the beginning of planned adjuvant therapies. These aspects demonstrate the important role of anesthesia in the treatment of patients with cancer. Further studies defining the relevance of anesthesiologic measures in oncologic patients are needed.

Postoperative infections after oesophageal resections: the role of blood transfusions

BACKGROUND

Perioperative blood transfusion carries numerous potential risks concerning the transmission of infective diseases and immunodepression that can facilitate the occurrence of postoperative infectious complications. Explanation of connections between perioperative blood transfusion and postoperative septic complication worldwide is not well documented. Many studies have described a correlation between perioperative blood transfusions and postoperative infections. On the contrary, other studies indicate that factors influencing the need for blood transfusions during surgery have a greater bearing than blood transfusion per se on the occurrence of postoperative complications.

PATIENTS AND METHODS

A prospective study was conducted in our Department on 110 consecutive patients undergoing oesophageal resection for primary cancer, in order to evaluate the incidence of postoperative infections related to perioperative allogenic blood transfusions. For each patient we preoperatively recorded in a computerized data-base several known risk-factors for postoperative infections; in detail we registered the administration of allogenic perioperative blood transfusions (period of administration, number of packages administered).

RESULTS

Among the enrolled 110 patients, 53 (48%) received perioperative blood transfusions: in this group postoperative infections (overall infective complications) occurred in 27 patients. After a multivariate analysis we observed that perioperative blood transfusions significantly affected as an independent variable the development of wound infections (p = 0.02).

CONCLUSION

Blood transfusions independently affected the incidence of wound infections in patients who underwent oesophageal resection for primary cancer.

The Effects of Perioperative Blood Transfusion on Morbidity and Mortality After Esophagectomy

The effect of blood transfusion on outcomes in esophageal surgery remains controversial. The contrasting conclusions drawn from a number of retrospective analyses with different methodologies create a landscape that is difficult to interpret. Because of the scope of esophageal resection, the need for blood transfusion cannot be eliminated. What recommendations then, if any, can be made for the practicing surgeon? First, surgeons and anesthesiologists need to reevaluate their transfusion thresholds. The age-old practice of keeping the hemoglobin above 10 g/dL has very little evidence-based support. A multicenter, randomized, controlled clinical trial in Canada demonstrated that a restrictive strategy of blood transfusion, in which patients were transfused only for a hemoglobin level of less than 7 g/dL, was at least as effective as and possibly was superior to a liberal transfusion strategy in critically ill patients. It has also been estimated that more than 25% of patients undergoing colorectal resections may receive at least one unit of unnecessary blood. Further, the immediate reduction in the hemoglobin concentration caused by the normovolemic hemodilution associated with surgery and crystalloid fluid replacement is not associated with any increased morbidity or mortality. If these data are examined in the context of the results of Langley and Tachibana indicating that a threshold amount of blood needs to be transfused to impact outcomes, it becomes even more important to limit transfusion to only the amount that is essential. Thus, surgeons and anesthesiologists should adopt a more stringent set of requirements for blood transfusion. Second, with the proven feasibility and reduction in infectious complications associated with autologous blood-donation programs, any patient who meets the criteria discussed here should be encouraged to participate in such a program. Although the effect of autologous blood on cancer outcomes remains unclear, the other advantages certainly make such a program worthy of consideration. This discussion leads to a final point, namely that patients should be encouraged, whenever possible, to participate in clinical trial research. The only way that the community of surgeons treating patients who have esophageal cancer can hope to address properly the question of how blood transfusion affects outcomes is with well-designed clinical trials. A large, multicenter, randomized trial (level I) would be ideal. Short of such a trial, inclusion criteria and study methodology should be discussed among various institutions to avoid the differences in studies that make direct comparisons of results among different investigators difficult and potentially meaningless. This measure would at least allow different level II to IV data to be compared directly with some validity.

Induction therapy does not increase surgical morbidity after esophagectomy for cancer

BACKGROUND

A complete pathological response after induction therapy for esophageal cancer offers survival benefits, but induction therapy may increase the risk of postoperative complications and mortality.

METHODS

We performed a retrospective review of consecutive patients who underwent esophagectomy for esophageal cancer to identify preoperative predictors of complications and assess the possible influence of induction therapy on surgical outcomes.

RESULTS

Between 1988 and 2003, 170 esophagectomies were performed on our service; 95 (55.9%) underwent surgery alone and 75 (44.1%) received preoperative chemotherapy, 35 of whom also had preoperative radiation therapy. Based on multivariable regression analyses, independent covariates for complication categories included performance status (pulmonary, cardiovascular, total complications, and death), age (cardiovascular and other complications), and FEV(1)% (pulmonary complications). Whether patients received induction therapy was unrelated to the incidence of postoperative complications.

CONCLUSIONS

We found no evidence that induction therapy adversely influences the incidence of postoperative morbidity or mortality after esophagectomy for cancer.

Pulmonary adenocarcinoma is associated with poor long-term survival after surgical resection. Effect of allogeneic blood transfusion

BACKGROUND

The significance of allogeneic blood transfusion in the prognosis of patients with nonsmall lung carcinoma (NSCLC) remains controversial. Reports have suggested that patients with adenocarcinoma have a worse prognosis from cancer than patients with squamous cell carcinoma (SCC), but this evidence is lacking in NSCLC. The objective of the current study was to elucidate the correlation between perioperative allogeneic blood transfusion and the prognosis in patients with adenocarcinoma and SCC.

METHODS

The study group comprised 329 consecutive patients (172 men and 157 women) with a mean age of 67 years who underwent lung resection between 1996 and 2003 in 1 unit. The clinicopathologic and survival data were compared between 62 patients (42.7%) with adenocarcinoma and 58 patients (48.3%) with SCC who received a perioperative blood transfusion and 83 patients (57.3 %) with adenocarcinoma and 126 patients (61.3%) with SCC who did not.

RESULTS

The overall surgical mortality rate was 3.9% (13 deaths). The median surgical blood loss was 380 mL (range, 125-4500 mL). The mean blood transfusion received was 1.9 U (range, 0-8 U). The overall actuarial 1, 3, and 5-year survival rates in the adenocarcinoma and SCC groups were 82.3%, 49.6%, and 19.4% and 87.9%, 71.7%, and 32.7%, respectively (P = 0.021). Multivariate analysis demonstrated that the factors that appeared to be independent prognostic factors in both groups were T-classification (P < 0.001), lymph node metastasis (P < 0.001), and postoperative complications (P = 0.029). Perioperative blood transfusion was not an independent prognostic indicator in either group.

CONCLUSIONS

The current study demonstrated that long-term survival in patients with adenocarcinoma of the lung was significantly worse compared with patients with SCC, but was independent of allogeneic perioperative blood transfusion. The results reaffirmed the importance of tumor invasion and lymph node involvement in the overall poor prognosis of these patients.

Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases

OBJECTIVE

To determine if transfusion affected perioperative and long-term outcome in patients undergoing liver resection for metastatic colorectal cancer.

SUMMARY BACKGROUND DATA

Blood transfusion produces host immunosuppression and has been postulated to result in adverse outcome for patients undergoing surgical resection of malignancies.

METHODS

Blood transfusion records and clinical outcomes for 1,351 patients undergoing liver resection at a tertiary cancer referral center were analyzed.

RESULTS

Blood transfusion was associated with adverse outcome after liver resection. The greatest effect was in the perioperative course, where transfusion was an independent predictor of operative mortality, complications, major complications, and length of hospital stay. This effect was dose-related. Patients receiving one or two units or more than two units had an operative mortality of 2.5% and 11.1%, respectively, compared to 1.2% for patients not requiring transfusions. Transfusion was also associated with adverse long-term survival by univariate analysis, but this factor was not significant on multivariate analysis. Even patients receiving only one or two units had a more adverse outcome.

CONCLUSIONS

Perioperative blood transfusion is a risk factor for poor outcome after liver resection. Blood conservation methods should be used to avoid transfusion, especially in patents currently requiring limited amounts of transfused blood products.

[Surgery for oesophageal cancer: current controversies]

Any attempt to define the present role of surgery in the treatment of oesophageal cancer should integrate the dramatic changes that occurred within this disease over the last 2 decades: major shift in the histologic type of tumours, improved staging methods, spectacular reduction of operative risks, standardization of oncologic principles focusing on the completeness of resection, and development of multimodality therapeutic strategies. Surgery has still a pivotal role. Esophagectomy should be performed by trained surgeons in high-volume institutions. Radical surgery with en-bloc resection and 2 fields lymphadenectomy, should be encouraged in low-risk patients with subcarinal tumors. Although multimodality treatment strategy is commonly applied for locally advanced disease, few data support its superiority over surgical resection alone, followed by adjuvant therapy when appropriate. One may thus hypothesize that the risk/benefit ratio of such strategies is probably optimal in case of early stage tumors, and future studies may further clarify this issue. Conversely, locally advanced tumors, particularly those located in the upper mediastinum and the neck, may be managed alternatively without surgery. However, surgery remains an important tool to ensure optimal palliation of dysphagia, to achieve local control, and finally to improve quality of life. In that way, video-assisted techniques and/or trans hiatal approaches aiming to minimize the surgical insult may have a place in the treatment of patients who have substantially responded to induction therapy. Tumors located close to the pharyngo-oesophageal junction are best managed with chemotherapy and radiotherapy. Finally, salvage surgery may be considered in highly selected patients in case of non-response or local relapse without distant metastases.

Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases

OBJECTIVE

To determine if transfusion affected perioperative and long-term outcome in patients undergoing liver resection for metastatic colorectal cancer.

SUMMARY BACKGROUND DATA

Blood transfusion produces host immunosuppression and has been postulated to result in adverse outcome for patients undergoing surgical resection of malignancies.

METHODS

Blood transfusion records and clinical outcomes for 1,351 patients undergoing liver resection at a tertiary cancer referral center were analyzed.

RESULTS

Blood transfusion was associated with adverse outcome after liver resection. The greatest effect was in the perioperative course, where transfusion was an independent predictor of operative mortality, complications, major complications, and length of hospital stay. This effect was dose-related. Patients receiving one or two units or more than two units had an operative mortality of 2.5% and 11.1%, respectively, compared to 1.2% for patients not requiring transfusions. Transfusion was also associated with adverse long-term survival by univariate analysis, but this factor was not significant on multivariate analysis. Even patients receiving only one or two units had a more adverse outcome.

CONCLUSIONS

Perioperative blood transfusion is a risk factor for poor outcome after liver resection. Blood conservation methods should be used to avoid transfusion, especially in patents currently requiring limited amounts of transfused blood products.

Immunologic effects of allogeneic versus autologous blood transfusion in patients undergoing radical oesophagectomy

Blood transfusion is often required in patients undergoing radical oesophagectomy, and is associated with immunosuppression that may worsen postoperative and long-term outcomes. However, the immunologic effects of allogeneic versus autologous transfusion have not been studied in this group of patients. We analyzed 103 patients who underwent radical oesophagectomy for oesophageal cancer, including 45 patients who received allogeneic transfusions (Allo), 16 patients who donated autologous blood but were not transfused (Auto-1) and 42 patients who received autologous transfusions (Auto-2). Peripheral blood lymphocyte subsets and natural killer (NK) cell activity were analyzed for 2 weeks postoperatively. Furthermore, the rate of infectious complications such as pneumonia and wound infection was compared. Patients receiving blood transfusion had decreased CD4+ lymphocyte counts and NK cell activity postoperatively, compared to Auto-1 patients. However, these abnormalities were corrected by day 14 in the Auto-2 group, but not in the Allo group. CD8+ lymphocyte counts were decreased in all groups postoperatively, returning to normal by 14 days in the Auto-1 group only. The rate of infectious complications was significantly higher in the Allo than in the Auto group. Blood transfusion is associated with adverse immunologic effects in patients undergoing radical oesophagectomy. However, autologous blood transfusion is favourable compared to allogeneic transfusion. Autologous transfusion programs should be employed when possible in this group of patients.

The influence of perioperative blood transfusion on survival after esophageal resection for carcinoma

BACKGROUND

There is evidence that perioperative blood transfusion may lead to immunosuppression. Our aim was to determine whether blood transfusion influenced survival after esophagectomy for carcinoma.

METHODS

The study group comprised 234 consecutive patients (175 men and 59 women) with a mean age of 66 years who underwent esophagectomy for carcinoma by one surgeon between 1988 and 1998. The impact of 41 variables on survival was determined by means of univariate and multivariate analysis. Follow-up was complete (mean follow-up, 19.2 months; standard deviation, 16 months; range, 0 to 129 months).

RESULTS

The operative mortality rate was 5.6% (13 deaths). Median operative blood loss was 700 mL (range, 150 to 7,000 mL). One hundred sixty-one patients (68.8%) received a blood transfusion postoperatively (mean transfusion, 2.6 units; range, 0 to 12 units). Overall actuarial 1-year, 3-year, and 5-year survival rates inclusive of operative mortality were 58.1%, 28.5%, and 16.1%, respectively. On univariate analysis, positive lymph nodes, pathological TNM stage, transfusion of more than 3 units of blood, incomplete resection, poor tumor cell differentiation, longer tumor, greater weight loss, male sex, and adenocarcinoma were significant (p < 0.05) negative factors for survival. On Cox proportional hazards regression analysis, after excluding operative mortality, lymph node involvement (p = 0.001), incomplete resection (p = 0.0001), poor tumor cell differentiation (p = 0.04), and transfusion of more than 3 units of blood (p = 0.04) were independent adverse predictors of late survival.

CONCLUSIONS

In addition to reaffirming the importance of completeness of resection and nodal involvement, this study demonstrates that blood transfusion (more than 3 units) may have a significant adverse effect on late survival after esophageal resection for carcinoma. Every effort should be made to limit the amount of transfused blood to the absolutely essential requirements.

Pharmacotherapy of anaemia in cancer patients

Anaemia is a common complication of cancer. The incidence is variable and depends on several factors. A linear correlation between haemoglobin levels and quality of life (QOL) parameters has been found. Erythropoiesis is a finely regulated responsive process and erythropoietin (EPO) is the most important factor influencing progenitor cell proliferation. Impaired EPO production is mediated by inflammatory cytokines liberated in cancer patients. For this reason, EPO has been proposed as an alternative to blood transfusions, which involve many hazards. EPO treatment has been found to be effective in preventing anaemia and reducing the need for blood transfusions, although it would be useful to identify high-risk patient subgroups who would benefit most from this expensive treatment.

Cellular immune response to autologous blood transfusion in hip arthroplasty: whole blood versus buffy coat-poor packed red cells and fresh-frozen plasma

BACKGROUND AND OBJECTIVES

Transfusion-induced immunomodulation by autologous blood is probably related to the buffy coat. Hence, in the present study, phagocytotic and oxidation activities of peripheral blood cells were investigated in hip arthroplasty patients exposed to autologous blood.

MATERIALS AND METHODS

Blood from 60 autologous donors was allocated at random to storage as whole blood (WB) or as buffy coat-poor packed red cells and fresh-frozen plasma (RCP). Phagocytotic and oxidation activities of neutrophils and monocytes, incidence of infections and length of hospital stay were compared among the groups of transfused (WB and RCP) and non-transfused (NT) patients.

RESULTS

Phagocytotic activities of neutrophils and monocytes were not significantly different among the WB, RCP and NT groups.

CONCLUSION

In the perioperative setting, a specific cellular immune response to autologous transfusion is not detectable.

Significance of allogenic blood transfusion on decreased survival in patients with esophageal carcinoma

BACKGROUND

To the authors' knowledge, the significance of allogenic blood transfusion in the prognosis of patients with esophageal carcinoma remains controversial. The objective of the current study was to elucidate the correlation, if any, between intraoperative allogenic blood transfusion and prognosis in patients with esophageal carcinoma.

METHODS

Two hundred fifty-nine patients with esophageal carcinoma who had undergone esophagectomy and reconstruction were studied. The clinicopathologic data and survival were compared between the 87 patients (33.6%) who received an intraoperative allogenic blood transfusion and the 172 patients (66.4%) who did not.

RESULTS

Multivariate analysis demonstrated that the factors that appeared to independently determine prognosis in patients with esophageal carcinoma were the depth of the tumor (P = 0.0001), lymph node metastasis (P < 0.0001), lymphatic invasion (P = 0.0002), venous invasion (P = 0.0008), and the occurrence of postoperative complications (P = 0.034). Intraoperative allogenic blood transfusion was not found to be an independent prognostic indicator.

CONCLUSIONS

In the current study, an advanced stage of disease at the time of surgery, which resulted in the need for blood transfusion and the occurrence of postoperative complications, appeared to worsen the prognosis in patients with esophageal carcinoma.