Impact of ABO-identical vs ABO-compatible nonidentical plasma transfusion in trauma patients

Hypothesis: Exposure to ABO-compatible nonidentical plasma will result in worse outcomes than transfusion with ABO-identical plasma only. Design: Retrospective study. Setting: Level I trauma center. Patients: All patients requiring plasma (from 2000-2008) were identified. Propensity scores were used to match patients exposed to ABO-compatible plasma with those receiving exclusively ABO-identical plasma. Main Outcome Measures: Mortality and complications (acute respiratory distress syndrome [ARDS]), sepsis, renal failure, and liver failure). Results: A total of 284 patients who received ABO-compatible nonidentical plasma were matched 1:1 with patients who received ABO-identical plasma only (230 group O, 39 A, and 15 B). ABO-compatible plasma did not affect mortality (35.2% vs 33.5%, P=.66). However, the overall complication rate was significantly higher for patients receiving ABO-compatible plasma (53.5% vs 40.5%, P=.002). The ARDS and sepsis rates were also significantly increased (19.4% vs 9.2%, P=.001, and 38.0% vs 28.9%, P=.02, respectively). As the volume of ABO-compatible plasma infused increased, a stepwise increase in complications was seen, reaching 70.0% for patients receiving more than 6 U. Patients receiving more than 6 U also had a 4-fold increase in ARDS. All recipient blood groups had an increase in overall complications, ARDS, and sepsis with exposure. This was significant for group O recipients with a higher risk of overall complications and ARDS (50.9% vs 40.0%, P=.03, and 17.4% vs 7.8%, P<.001, respectively). Conclusions: Exposure to ABO-compatible plasma results in an increase in overall complications, in particular ARDS and sepsis. There is a stepwise increase in the complication rate as exposure increases. Further prospective evaluation of the impact of limiting factor replacement to ABO-identical plasma only is warranted.