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Klapper JA, Hicks AC, Ledbetter L, Poisson J, Hartwig MG, Hashmi N, Welsby I, Bottiger BA. Blood product transfusion and lung transplant outcomes: A systematic review. Clin Transplant 2021; 35:e14404. [PMID: 34176163 DOI: 10.1111/ctr.14404] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/13/2021] [Accepted: 06/16/2021] [Indexed: 12/01/2022]
Abstract
The perioperative transfusion of blood products has long been linked to development of acute lung injury and associated with mortality across both medical and surgical patient populations.1,2 The need for blood product transfusion during and after lung transplantation is common and, in many instances, unavoidable. However, this practice may potentially be modifiable.3 In this systematic review, we explore and summarize what is known regarding the impact of blood product transfusion on outcomes following lung transplantation, highlighting the most recent work in this area. Overall, the majority of the literature consists of single center retrospective analyses or the work of multicenter working groups referencing the same database. In the end, there are a number of remaining questions regarding blood product transfusion and their downstream effects on graft function and survival.
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Affiliation(s)
- Jacob A Klapper
- Division of Cardiothoracic Surgery, Duke University, Durham, North California, USA
| | - Anne C Hicks
- Division of Cardiothoracic Anesthesiology, Duke University, Durham, North California, USA
| | - Leila Ledbetter
- Duke University, Medical Center Library, Durham, North California, USA
| | - Jessica Poisson
- Department of Pathology, Duke University, Durham, North California, USA
| | - Matthew G Hartwig
- Division of Cardiothoracic Surgery, Duke University, Durham, North California, USA
| | - Nazish Hashmi
- Division of Cardiothoracic Anesthesiology, Duke University, Durham, North California, USA
| | - Ian Welsby
- Division of Cardiothoracic Anesthesiology, Duke University, Durham, North California, USA
| | - Brandi A Bottiger
- Division of Cardiothoracic Anesthesiology, Duke University, Durham, North California, USA
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2
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Weller A, Seyfried T, Ahrens N, Baier-Kleinhenz L, Schlitt HJ, Peschel G, Graf BM, Sinner B. Cell Salvage During Liver Transplantation for Hepatocellular Carcinoma: A Retrospective Analysis of Tumor Recurrence Following Irradiation of the Salvaged Blood. Transplant Proc 2021; 53:1639-1644. [PMID: 33994180 DOI: 10.1016/j.transproceed.2021.03.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/04/2021] [Accepted: 03/17/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Orthotopic liver transplantation (OLT) is the treatment option for early-stage hepatocellular carcinoma (HCC). OLT is often associated with high blood loss, requiring blood transfusion. Retransfusion of autologous blood is a key part of blood conservation. There are, however, concerns that the retransfusion of salvaged blood might cause the spread of cancer cells and induce metastasis. Irradiation of salvaged blood before retransfusion eliminates viable cancer cells. Here, we analyzed the incidence of tumor recurrence in patients with HCC undergoing OLT who received irradiated cell-salvaged blood during transplant surgery. METHODS We retrospectively analyzed patients undergoing OLT for HCC between 2002 and 2018 at our center. We compared the tumour recurrence in patients who received no retransfusion of autologous blood with patients who received autologous blood with or without preceding irradiation of the blood. RESULTS Fifty-one (40 male, 11 female) patients were included in the analysis; 10 patients developed tumor recurrence within a time period of 2.45 ± 2.0 years. Statistical analysis revealed that there was no significant difference in tumor recurrence between patients who received autologous blood with or without irradiation. CONCLUSION Intraoperative transfusion of cell-salvaged blood did not increase tumor recurrence rates. Cell salvage should be used in liver transplantation of HCC patients as part of a blood conservation strategy. The effect of blood irradiation on tumor recurrence could not be definitively evaluated.
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Affiliation(s)
- Astrid Weller
- Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Timo Seyfried
- Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Norbert Ahrens
- Department of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | | | | | - Georg Peschel
- Department of Internal Medicine, University of Regensburg, Regensburg, Germany
| | - Bernhard M Graf
- Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Barbara Sinner
- Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany.
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3
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Cho S, Park J, Lee M, Lee D, Choi H, Gim G, Kim L, Kang CY, Oh Y, Viveiros P, Vagia E, Oh MS, Cho GJ, Bharat A, Chae YK. Blood transfusions may adversely affect survival outcomes of patients with lung cancer: a systematic review and meta-analysis. Transl Lung Cancer Res 2021; 10:1700-1710. [PMID: 34012786 PMCID: PMC8107741 DOI: 10.21037/tlcr-20-933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Despite common use in clinical practice, the impact of blood transfusions on prognosis among patients with lung cancer remains unclear. The purpose of the current study is to perform an updated systematic review and meta-analysis to evaluate the influence of blood transfusions on survival outcomes of lung cancer patients. Methods We searched PubMed, Embase, Cochrane Library, and Ovid MEDLINE for publications illustrating the association between blood transfusions and prognosis among people with lung cancer from inception to November 2019. Overall survival (OS) and disease-free survival (DFS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using the random-effects model. Study heterogeneity was evaluated with the I2 test. Publication bias was explored via funnel plot and trim-and-fill analyses. Results We included 23 cohort studies with 12,175 patients (3,027 cases and 9,148 controls) for meta-analysis. Among these records, 22 studies investigated the effect of perioperative transfusions, while one examined that of transfusions during chemotherapy. Two studies suggested the possible dose-dependent effect in accordance with the number of transfused units. In pooled analyses, blood transfusions deleteriously influenced both OS (HR=1.35, 95% CI: 1.14–1.61, P<0.001, I2=0%) and DFS (HR=1.46, 95% CI: 1.15–1.86, P=0.001, I2=0%) of people with lung cancer. No evidence of significant publication bias was detected in funnel plot and trim-and-fill analyses (OS: HR=1.26, 95% CI: 1.07–1.49, P=0.006; DFS: HR=1.35, 95% CI: 1.08–1.69, P=0.008). Conclusions Blood transfusions were associated with decreased survival of patients with lung cancer.
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Affiliation(s)
- Sukjoo Cho
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jonghanne Park
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Misuk Lee
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dongyup Lee
- Department of Physical Medicine and Rehabilitation, Geisinger Health System, Danville, PA, USA
| | - Horyun Choi
- Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA
| | - Gahyun Gim
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Leeseul Kim
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cyra Y Kang
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Youjin Oh
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pedro Viveiros
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elena Vagia
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael S Oh
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ankit Bharat
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Young Kwang Chae
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
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4
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Huddleston SJ, Jackson S, Kane K, Lemke N, Shaffer AW, Soule M, Hertz M, Shumway S, Qi S, Perry T, Kelly R. Separate Effect of Perioperative Recombinant Human Factor VIIa Administration and Packed Red Blood Cell Transfusions on Midterm Survival in Lung Transplantation Recipients. J Cardiothorac Vasc Anesth 2020; 34:3013-3020. [DOI: 10.1053/j.jvca.2020.05.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 11/11/2022]
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5
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Subramaniam K, Huang J, Weitzel N, Kertai MD. Thoracic Transplant Anesthesiology: Keeping Up With Advances and Developments of Allied Specialties. Semin Cardiothorac Vasc Anesth 2020; 24:5-8. [PMID: 31994441 DOI: 10.1177/1089253219900719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Nathaen Weitzel
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Pena JJ, Bottiger BA, Miltiades AN. Perioperative Management of Bleeding and Transfusion for Lung Transplantation. Semin Cardiothorac Vasc Anesth 2019; 24:74-83. [DOI: 10.1177/1089253219869030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Perioperative allogeneic blood product transfusion is common in lung transplantation and has various implications on the short- and long-term outcomes of lung recipients. This review summarizes the effect of transfusion on outcomes including primary graft dysfunction, chronic lung allograft dysfunction, and all-cause mortality. We outline known risk factors for increased transfusion requirement in lung transplantation and present current evidence regarding the effect of hemostatic agents including antifibrinolytics, recombinant factor VII, and prothrombin complex concentrates. Finally, we highlight the roles of point-of-care coagulation testing and goal-directed transfusion strategies in reducing transfusion requirements in lung transplantation.
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Cernak V, Oude Lansink-Hartgring A, van den Heuvel ER, Verschuuren EAM, van der Bij W, Scheeren TWL, Engels GE, de Geus AF, Erasmus ME, de Vries AJ. Incidence of Massive Transfusion and Overall Transfusion Requirements During Lung Transplantation Over a 25-Year Period. J Cardiothorac Vasc Anesth 2019; 33:2478-2486. [PMID: 31147209 DOI: 10.1053/j.jvca.2019.03.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/12/2019] [Accepted: 03/26/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To establish the incidence of massive transfusion and overall transfusion requirements during lung transplantation, changes over time, and association with outcome in relation to patient complexity. DESIGN Retrospective cohort study. SETTING University hospital. PARTICIPANTS All 514 adult patients who underwent transplantation from 1990 until 2015. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patient records and transfusion data, divided into 5-year intervals, were analyzed. The incidence of massive transfusion (>10 units of red blood cells [RBCs] in 24 h) was 27% and did not change over time, whereas the median (interquartile range) transfusion requirement in the whole cohort decreased from 8 (5-12) to 3 (0-10) RBCs (p < 0.001). In patients transplanted from the intensive care unit, the incidence of massive transfusion increased over time from 25% to 54% (p = 0.04) and median transfusion requirements from 4.5 (3-8.5) units to 14.5 (5-26) units of RBCs (p = 0.03). Multivariable analysis showed that circulatory support, pulmonary hypertension, re-transplantation, cystic fibrosis, Eisenmenger syndrome, bilateral transplantation, and low body mass index were associated with massive transfusion. Patients with massive transfusion had more primary graft dysfunction grade III at 0, 24, 48, and 72 hours (p < 0.001), higher 30-day mortality (13% v 4%; p < 0.001), and lower 5-year survival (hazard ratio 3.67 [95% confidence interval 1.72-7.85]; p < 0.001). CONCLUSION The incidence of massive transfusion did not change over time, whereas transfusion requirements in the whole cohort decreased. In patients transplanted from the intensive care unit, massive transfusion and transfusion requirements increased. Massive transfusion was associated with poor outcome.
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Affiliation(s)
- Vladimir Cernak
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | | | - Edwin R van den Heuvel
- Department of Mathematics and Computer Science, Technical University Eindhoven, Eindhoven, The Netherlands
| | - Erik A M Verschuuren
- Department of Pulmonary Diseases and Lung Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wim van der Bij
- Department of Pulmonary Diseases and Lung Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas W L Scheeren
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Arian F de Geus
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel E Erasmus
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrianus J de Vries
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Smith I, Pearse BL, Faulke DJ, Naidoo R, Nicotra L, Hopkins P, Ryan EG. Targeted Bleeding Management Reduces the Requirements for Blood Component Therapy in Lung Transplant Recipients. J Cardiothorac Vasc Anesth 2017; 31:426-433. [DOI: 10.1053/j.jvca.2016.06.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Indexed: 11/11/2022]
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9
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Ong LP, Sachdeva A, Ramesh BC, Muse H, Wallace K, Parry G, Clark SC. Lung Transplant With Cardiopulmonary Bypass: Impact of Blood Transfusion on Rejection, Function, and Late Mortality. Ann Thorac Surg 2016; 101:512-9. [DOI: 10.1016/j.athoracsur.2015.07.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 07/16/2015] [Accepted: 07/20/2015] [Indexed: 11/29/2022]
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10
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Ong LP, Thompson E, Sachdeva A, Ramesh B, Muse H, Wallace K, Parry G, Clark SC. Allogeneic blood transfusion in bilateral lung transplantation: impact on early function and mortality. Eur J Cardiothorac Surg 2015; 49:668-74; discussion 674. [DOI: 10.1093/ejcts/ezv155] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/12/2015] [Indexed: 01/09/2023] Open
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George MP, Novelli EM, Shigemura N, Simon MA, Feingold B, Krishnamurti L, Morrell MR, Gries CG, Haider S, Johnson BA, Crespo MM, Bhama JK, Bermudez C, Yousem SA, Toyoda Y, Champion HC, Pilewski JM, Gladwin MT. First successful lung transplantation for sickle cell disease with severe pulmonary arterial hypertension and pulmonary veno-occlusive disease. Pulm Circ 2014; 3:952-8. [PMID: 25006411 DOI: 10.1086/674749] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 06/30/2013] [Indexed: 01/14/2023] Open
Abstract
Little is known about the use of lung transplantation in the management of sickle cell disease-associated pulmonary arterial hypertension (SCD-PAH). We present clinical and pathological data and report the first successful outcome of bilateral lung transplantation in a patient with severe SCD-PAH and pulmonary veno-occlusive disease (PVOD). We discuss the complexities of multidisciplinary planning and management of lung transplantation in patients with SCD-associated pulmonary vascular complications. This case reports the first documented successful lung transplant and first case of PVOD in a patient with SCD-PAH.
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Affiliation(s)
- M Patricia George
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Enrico M Novelli
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Norihisa Shigemura
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marc A Simon
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brian Feingold
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA ; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lakshmanan Krishnamurti
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA ; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew R Morrell
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Cynthia G Gries
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Syed Haider
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Bruce A Johnson
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Maria M Crespo
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jay K Bhama
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Christian Bermudez
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Samuel A Yousem
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yoshiya Toyoda
- Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Hunter C Champion
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joseph M Pilewski
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mark T Gladwin
- Departments of Medicine, Pediatrics, Pathology, and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Effect of reverse chimerism on rejection in clinical transplantation. Ann Plast Surg 2013; 71:615-20. [PMID: 24126344 DOI: 10.1097/01.sap.0000437314.05306.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chimerism may enable allografts to survive when immunosuppressive therapy is administered at low levels or is even absent. Reverse chimerism (RC) is focused on intragraft chimerism that repopulates the allograft with cells of recipient origin. We aimed to identify and analyze current clinical evidence on RC and the presence of endothelial RC and tissue-specific RC. A total of 33 clinical reports on cardiac, kidney, liver, and lung transplants published between 1972 and 2012 that focused on RC were included in a systematic review. Liver allografts presented with the highest percentage of endothelial RC and lung allografts by far the lowest. Tissue-specific RC was present in most of the recipients, but at very low levels. There were also cardiac and kidney allografts with chimerism, but the functionality of the cells of recipient origin was questionable. We were unable to determine whether RC was a trigger for or a result of acute rejection. Further clinical research should focus on outcomes to evaluate the clinical relevance of this form of chimerism in transplantation.
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Subramanian A, Berbari EF, Brown MJ, Allen MS, Alsara A, Kor DJ. Plasma Transfusion Is Associated With Postoperative Infectious Complications Following Esophageal Resection Surgery: A Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2012; 26:569-74. [DOI: 10.1053/j.jvca.2011.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Indexed: 12/26/2022]
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14
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Poesen R, Bammens B, Claes K, Kuypers D, Vanrenterghem Y, Monbaliu D, Evenepoel P. Prevalence and determinants of anemia in the immediate postkidney transplant period. Transpl Int 2011; 24:1208-15. [DOI: 10.1111/j.1432-2277.2011.01340.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Mangi AA, Mason DP, Nowicki ER, Batizy LH, Murthy SC, Pidwell DJ, Avery RK, McCurry KR, Pettersson GB, Blackstone EH. Predictors of Acute Rejection After Lung Transplantation. Ann Thorac Surg 2011; 91:1754-62. [DOI: 10.1016/j.athoracsur.2011.01.076] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 01/19/2011] [Accepted: 01/21/2011] [Indexed: 11/25/2022]
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Kotter J, Drakos S, Horne B, Hammond E, Stehlik J, Bull D, Reid B, Gilbert E, Everitt M, Alharethi R, Budge D, Verma D, Li Y, Kfoury A. Effect of Blood Product Transfusion–Induced Tolerance on Incidence of Cardiac Allograft Rejection. Transplant Proc 2010; 42:2687-92. [DOI: 10.1016/j.transproceed.2010.05.167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Revised: 05/03/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022]
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