The impact of two different transfusion strategies on patient immune response during major abdominal surgery: a preliminary report

Kassiani Theodoraki, Maria Markatou, Demetrios Rizos, Argyro Fassoulaki, Kassiani Theodoraki, Maria Markatou, Demetrios Rizos, Argyro Fassoulaki

Abstract

Blood transfusion is associated with well-known risks. We investigated the difference between a restrictive versus a liberal transfusion strategy on the immune response, as expressed by the production of inflammatory mediators, in patients subjected to major abdominal surgery procedures. Fifty-eight patients undergoing major abdominal surgery were randomized preoperatively to either a restrictive transfusion protocol or a liberal transfusion protocol (with transfusion if hemoglobin dropped below 7.7 g dL(-1) or 9.9 g dL(-1), respectively). In a subgroup of 20 patients randomly selected from the original allocation groups, blood was sampled for measurement of IL-6, IL-10, and TNFα. Postoperative levels of IL-10 were higher in the liberal transfusion group on the first postoperative day (49.82 ± 29.07 vs. 15.83 ± 13.22 pg mL(-1), P < 0.05). Peak postoperative IL-10 levels correlated with the units of blood transfused as well as the mean duration of storage and the storage time of the oldest unit transfused (r(2) = 0.38, P = 0.032, r(2) = 0.52, P = 0.007, and r(2) = 0.68, P<0.001, respectively). IL-10 levels were elevated in patients with a more liberal red blood cell transfusion strategy. The strength of the association between anti-inflammatory IL-10 and transfusion variables indicates that IL-10 may be an important factor in transfusion-associated immunomodulation. This trial is registered under ClinicalTrials.gov Identifier: NCT02020525.

Figures

Figure 1
Figure 1
(a) Serial changes in perioperative IL-6 levels. Data are presented as mean ± SD. No intergroup differences were demonstrated. (P < 0.001, effect of time; P = 0.462, group by time interaction). (b) Serial changes in perioperative IL-10 levels. Data are presented as mean ± SD. Postoperative systemic induction of IL-10 was significantly exaggerated in the liberal transfusion group 24 h postoperatively. (*P < 0.05 for intergroup comparison; P < 0.001, effect of time; P < 0.001, group by time interaction). (c) Serial changes in perioperative TNFα levels. Data are presented as mean ± SD. There was a difference between the two groups on the third postoperative day. (*P < 0.05 for intergroup comparison; P = 0.842, effect of time; P = 0.029, group by time interaction).
Figure 2
Figure 2
Scatter plot diagram of peak postoperative IL-10 values versus the number of units transfused, depicting a significant correlation (r2 = 0.38, P = 0.032).
Figure 3
Figure 3
Scatter plot diagram of peak postoperative IL-10 values versus the mean duration of storage of transfused blood (in days). The storage time of transfused blood demonstrated a strong correlation to peak IL-10 values (r2 = 0.52, P = 0.007).
Figure 4
Figure 4
Scatter plot diagram of peak postoperative IL-10 values versus the duration of storage (in days) of the oldest unit of blood transfused. A strong correlation between the storage time of the oldest unit transfused and peak IL-10 values was demonstrated (r2 = 0.68, P < 0.001).
Figure 5
Figure 5
Scattergraph of peak postoperative IL-10 values in the seven patients who developed postoperative complications and in the 13 patients who did not. A trend for higher peak IL-10 values in the patients with complications was demonstrated (P = 0.09).

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