WBC-containing Allogeneic Blood Transfusion and Mortality: A Meta-Analysis of Randomized Controlled Trials

Transfusion. 2003 Jul;43(7):963-73. doi: 10.1046/j.1537-2995.2003.00426.x.


Background: An association between allogeneic blood transfusion (ABT) and mortality was reported by one team of investigators from randomized controlled trials (RCTs) comparing recipients of non-WBC-reduced versus WBC-reduced RBCs in open-heart surgery. A meta-analysis was undertaken to examine whether this finding can be generalized across clinical settings and/or transfused RBC components.

Study design and methods: RCTs reporting on adverse immunomodulatory effects of ABT between January 1992 and August 2002 were retrieved. Fourteen studies had recorded mortality as a primary or secondary outcome and met all other criteria for meta-analysis. Summary ORs of mortality in a treatment arm receiving WBC-containing allogeneic RBCs versus a control arm receiving autologous or WBC-reduced allogeneic RBCs were calculated across studies, for groups of studies in which the hypothesis of homogeneity was not rejected.

Results: There was no association between ABT and mortality across 14 RCTs reporting on short-term mortality (summary OR, 1.20; 95% CI, 0.87-1.65) or across 3 RCTs reporting on long-term mortality (summary OR, 0.87; 95% CI, 0.64-1.19). In subgroup analyses, RCTs using autologous blood or conducted in abdominal or vascular surgery showed no difference in mortality, but short-term mortality differed across 3 RCTs conducted in open-heart surgery (summary OR, 2.26; 95% CI, 1.31-3.90; p < 0.05) and 7 RCTs comparing recipients of non-WBC-reduced versus WBC-reduced allogeneic RBCs filtered before storage (summary OR, 1.45; 95% CI, 1.00-2.11; p >/= 0.05).

Conclusions: An association between ABT and either short-term or long-term mortality was not detected across clinical settings and transfused RBC components, but subgroup analyses suggest that an association between WBC-containing ABT and short-term mortality may exist in open-heart surgery and in settings where WBC-reduced allogeneic RBCs filtered before storage are administered.

Publication types

  • Meta-Analysis

MeSH terms

  • Blood Component Removal*
  • Blood Transfusion, Autologous
  • Cardiac Surgical Procedures / mortality
  • Colorectal Neoplasms / surgery
  • Erythrocyte Transfusion / mortality*
  • HIV Seropositivity / therapy
  • Humans
  • Leukocytes*
  • Odds Ratio
  • Randomized Controlled Trials as Topic*
  • Transplantation, Homologous
  • Vascular Surgical Procedures