Prestorage Leukoreduction of Transfused Red Cells Is Associated with Significant Ongoing 2–12 Month Survival Benefit in Cardiac Surgery Patients.

Abstract

Abstract Introduction: Red cell (RBC) transfusion (vs no transfusion) in cardiac surgery is associated with higer operative mortality and shortened long-term survival. Studies have suggested use of leukoreduced RBCs vs standard RBCs in transfused cardiac surgery patients is associated with improved short term (60 day) survival. It is unclear if this benefit persists longer term. Study Aim: This prospective, randomized, double-blind, 3-center trial compared short term and intermediate-term mortality (2–12 mos) in adult cardiac surgery patients undergoing cardiopulmonary bypass (CPB) randomized to receive either prestorage leukoreduced RBCs (LR-RBCs) vs standard RBCs (S-RBCs) Methods: 1226 cardiac surgery patients (undergoing coronary artery bypass grafting, cardiac valve replacement, or a combination of the two) were pre-operatively randomized to receive either LR- or S-RBCs. Patients were operated on by the same group of surgeons. Patients and clinicians were blinded as to product type. All deaths were verified by National Death Index records. Results: 562 patients (45.8%) were transfused: 304 received LR-RBCs and 258 S-RBCs. Groups were statistically equivalent demographically and by all Society of Thoracic Surgery risk criteria. Operative mortality was not affected. However a survival benefit for the LR-RBC group was evident at 60 days which persisted for 12 months (see Table 1). Mortality for non-transfused patients was significantly lower than for patients receiving either LR- or S-RBCs at all time points (p<0.0001). Conclusion: In adult cardiac surgery patients undergoing CPB who require transfusion, use of LR-RBCs vs S-RBCs is associated with significant improvement in survival at 2 months, and this survival advantage persists for up to 1 year. Table 1: Percent (%) Mortality--Operative (Op) and Cumulative by Month (mo) Post-operative Op 2 mo 4 mo 6 mo* 9 mo* 12 mo* *Kaplan-Meier (KM) analysis LD-RBCs 4.9 4.9 5.3 5.9 5.9 7.0 S-RBCs 7.0 9.7 9.7 10.1 11.3 11.7 p-value 0.305 0.029 0.044 0.070 0.025 0.053