TY - JOUR
T1 - Impact of ABO-identical vs ABO-compatible nonidentical plasma transfusion in trauma patients
AU - Inaba, Kenji
AU - Branco, Bernardino C.
AU - Rhee, Peter
AU - Holcomb, John B.
AU - Blackbourne, Lorne H.
AU - Shulman, Ira
AU - Nelson, Janice
AU - Demetriades, Demetrios
N1 - Copyright:
Copyright 2015 Elsevier B.V., All rights reserved.
PY - 2010/9
Y1 - 2010/9
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=77957064497&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77957064497&partnerID=8YFLogxK
U2 - 10.1001/archsurg.2010.175
DO - 10.1001/archsurg.2010.175
M3 - Article
C2 - 20855762
AN - SCOPUS:77957064497
VL - 145
SP - 899
EP - 906
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 9
ER -