Effect of perioperative allogeneic blood transfusion on the prognostic quality of first-stage free flap repair and reconstruction in patients with oral cancer / 中国输血杂志

【Objective】 To study the effect of perioperative allogeneic blood transfusion on patients with oral squamous cell carcinoma (OSCC) after first-stage free flap transplantation. 【Methods】 A total of 306 OSCC patients who accepted primary repair and reconstruction using free flap admitted to our affiliation from January 2010 to January 2019 were selected as the research objects and retrospectively analyzed. According to their clinical data, they were divided into three groups: no transfusion group (n=98), 1-2 U transfusion group (n=131) and 3 + U transfusion group (n=77), respectively. The incidence of complications including flap infection, blood circulation disorder and hematoma in the three groups were compared. The five-year survival rate of the three groups was calculated by Kaplan-Meier analysis, and the relative risk of death was analyzed by Cox regression. 【Results】 There was no statistically significant difference among the three groups of patients (P>0.05) regarding such baseline data as embracing gender, age, primary location, degree of differentiation, adjuvant radiotherapy and chemotherapy. The complication rate of patients with 3 + U transfusion (25.97%) was significantly higher than that of no transfusion (6.12%) and 1-2 U transfusion (10.86%) (P<0.05); and the five-year survival rate of patients with 3 + U transfusion (51.95%) was significantly lower than that of no transfusion (69.38%) and 1-2 U transfusion (62.60%) (P<0.05). The results of univariate analysis showed that age, adjuvant radiotherapy, degree of tissue differentiation, collateral infiltration, vascular invasion and blood transfusion were all factors influencing the quality of prognosis after repair and reconstruction of first-stage free flap transplantation treating OSCC (P<0.05). The results of multivariate analysis showed that adjuvant chemoradiotherapy was an independent protective factor for the prognosis and survival quality of postoperative OSCC patients (P<0.01); the degree of differentiation, vascular invasion and blood transfusion were independent risk factors for the prognosis and survival quality of postoperative OSCC patients (P<0.05). 【Conclusion】 Perioperative allogeneic transfusion in OSCC patients can increase the risk of postoperative complications and directly affect their prognostic quality. It can be regarded as an important risk factor for OSCC patients.

Implications of perioperative allogeneic red blood cell transfusion on the immune-inflammatory response

ABSTRACT Background: The allogeneic transfusion-related immunomodulation (TRIM) may be responsible for an increase in survival of renal transplants but in contrast it could increase the rate of bacterial infections or the recurrence rate of tumors post-operatively. Objective: This review focuses in the implications of perioperative allogeneic transfusions on the immune-inflammatory response of surgical transfused patients. Results: ABTs modify immune functions in recipients including decrease of the number of lymphocytes; decrease the CD4 cells; decrease the CD4/CD8 T-cell ratio; decrease NK cells; and decrease the lymphocyte response to mitogens. TRIM effects may be mediated by allogeneic white cells present in blood products; soluble peptides present in transfused plasma; and/or biologic mediators released into the supernatant of blood units. A recent systematic review and meta-analysis including 36 clinical observational studies (n = 174,036) concluded that perioperative ABTs not only decreased overall survival and reduced colorectal cancer-specific survival. Furthermore ABTs increased the rate of infectious, cardiac, pulmonary and anastomotic complications in colorectal cancer patients undergoing surgery. Conclusions: It has been demonstrated by laboratory tests that TRIM is associated with transfusion recipient immune alterations but its influence in colorectal cancer recurrence after resection remains controversial though may exist. Surgical techniques reducing intraoperative blood loss have limited the number of ABTs perioperatively, however increase in mortality continues to be reported in literature after ABT in colorectal cancer surgery. Poor survival associated to TRIM in colorectal cancer might be due to higher number of allogeneic transfused units and/or prolonged length of blood storage.

Effect of Autologous Blood Transfusion on Postoperative Levels of IL-6,IFN-?,and TNF-? after Spinal Operation / 中国微创外科杂志

Objective To compare the effect of allogeneic and autologous blood transfusion on postoperative immunoreaction in patients after spinal surgeries.Methods A total of 44 patients undergoing spinal operations were randomly divided into two groups.Allogeneic (n=22) or autologous (n=22) buffy-coat-depleted red cells were used in the patients during the operations.The serum levels of IL-6,IFN-?,and TNF-?were determined preoperatively and then re-measured 1 and 7 days after the operations. Results In theautologous group,both IFN-?and IL-6 increased after the oprerations,the level of IL-6 was significantly higher than that in the allogeneic group at days 1 and 7.The concentration of TNF-?did not change after the surgeries in the two groups. Conclusions By autologous blood transfusion,the serum levels of IFN-?and IL-6 can be increased significantly after spinal operation,meanwhile the concentration of TNF-?remains stable.The postoperative inhibitory effect of the procedure on immunocytokines is significantly weaker than that of allogeneic blood transfusion,indicating that autologous blood transfuion can protect or even increase immunofunction after spinal operation.

Alternation of Cytokine mRNA Expression in Human Blood Samples before and after Allogeneic Transfusions / 대한진단검사의학회지

BACKGROUND: Despite proposing clonal depletion, anergy, and alternation of cytokines in peripheral tolerance, the precise mechanism for the immunosuppressive effect of blood transfusion remains unknown. Here, we evaluated the effect of transfusion on the immune system indirectly via quantitation of leukocyte cytokine mRNA expression before and after allogeneic transfusion. METHODS: Samples were obtained from eight patients, being ordered one to four units of leukocytefree erythrocytes, before, 1, and 7 days after transfusion, from November to December, 2002 at Inha University Hospital. We explored the changes in mRNA expression of interleukin-2 (IL-2), IL-4, IL-10, tumor necrosis factor alpha (TNF-alpha) and interferon gamma (IFN-gamma). RESULTS: In four patients who received blood transfusions among eight, significant changes were observed in the blood mRNA levels of INF-gamma and IL-10. The amounts of IFN-gamma mRNA were significantly decreased a day after transfusion to 78.5% and then recovered to 110.9% 7 days later (P=0.032), whereas, that of IL-10 was increased to 151.5% a day after and recovered to 119.1% 7 days later (P=0.034). mRNA expressions of IL-2, IL-4, and TNF-alpha were not detected in all patients. CONCLUSIONS: We observed a significant decrease in leukocyte IFN-gamma mRNA expression and an increase in IL-10 mRNA after transfusion. These findings indirectly represent that down-regulation of the Th1 cells and the up-regulation of the Th2 cells could be caused by allogeneic transfusion.

Strategy to reduce allogeneic transfusion in the perioperative periods of open heart surgical procedures / 中国输血杂志

Objective To provide a strategy for open heart surgical procedures of reducing allogeneic transfusion in the perioperative periods.Methods A comprehensive blood conservation program and new transfusion criteria[haemoglobin(Hb)were0.05).The Hct was down after operation in both groups.In the test group the Hct decreased in to 30% at day7 postoperation and regained gradually after 14 days of operation.Conclusion The dininishing allogeneic transfusion can be achieved by application of comprehensive blood conservation techniques and new transfusion criterion during the perioperative periods of open heart surgical procedures.The operative curative effect is not influence thereby.