S. Kwon3, R. S. Chamberlain1,2,3 1Saint Barnabas Medical Center,Surgery,Livingston, NJ, USA 2New Jersey Medical School,Surgery,Newark, NJ, USA 3St. George’s University School Of Medicine,St. George’s, St. George’s, Grenada
Introduction: Leucocyte filtered blood (LFB) has been shown to prevent cytomegalovirus reactivation, HLA immunization and recurrent febrile non-hemolytic reactions. LFB has been reported to decrease postoperative infections, however, prior reports are conflicting and contradictory. This meta-analysis examines the impact of LFB on the overall incidence of postoperative infections.
Methods: A comprehensive literature search of PubMed, Google Scholar, and the Cochrane Central Registry of Controlled Trials from January 1966 to July 2015 was conducted. Keywords included in the search were ‘leuk(c)oreduced’, ‘leuk(c)odepleted’, ‘filtered’, ‘white cell reduced’, ‘leuk(c)ocyte reduced’, ‘leuk(c)ocyte depleted’, and transfusions. Studies that compared LFB to non-leucocyte filtered blood and reporting postoperative infections were included. Outcomes analyzed included postoperative infections under ‘as per protocol’ (APP) and ‘intention-to-treat’ (ITT), as well as length of stay (LOS).
Results: 16 RCTs involving 6,776 randomized (ITT) patients (4,514 transfused (APP) patients) in various clinical settings (7 cardiac, 5 colorectal, and 4 other) were evaluated. The LFB group had an overall 25.6% reduction in postoperative infection risk when analyzed by APP (RR=0.744; 95% CI [0.593-0.934]; p=0.011) and 21.7% risk reduction when analyzed by ITT (RR=0.783; 95% CI [0.646-0.949]; p=0.013). When analyzed by APP, cardiac and colorectal surgeries derived the greatest infection reduction benefit (RR=0.748; 95% CI [0.623-0.897]; p=0.002 and RR=0.447; 95% CI [0.199-1.006]; p=0.052). LFB was also associated with a significant reduction in LOS (Standardized Difference of Mean (SDM) =-0.539; 95% CI [-1.038- -0.0040]; p=0.034).
Conclusion: LFB transfusions are associated with a significant decrease in postoperative infections for both APP and ITT populations, particularly in cardiac surgery patients. Additional adequately powered studies are needed to fully understand the benefits of LFB.
