Immunologic effects of allogeneic versus autologous blood transfusion in patients undergoing radical oesophagectomy

Abstract

Blood transfusion is often required in patients undergoing radical oesophagectomy, and is associated with immunosuppression that may worsen postoperative and long-term outcomes. However, the immunologic effects of allogeneic versus autologous transfusion have not been studied in this group of patients. We analyzed 103 patients who underwent radical oesophagectomy for oesophageal cancer, including 45 patients who received allogeneic transfusions (Allo), 16 patients who donated autologous blood but were not transfused (Auto-1) and 42 patients who received autologous transfusions (Auto-2). Peripheral blood lymphocyte subsets and natural killer (NK) cell activity were analyzed for 2 weeks postoperatively. Furthermore, the rate of infectious complications such as pneumonia and wound infection was compared. Patients receiving blood transfusion had decreased CD4+ lymphocyte counts and NK cell activity postoperatively, compared to Auto-1 patients. However, these abnormalities were corrected by day 14 in the Auto-2 group, but not in the Allo group. CD8+ lymphocyte counts were decreased in all groups postoperatively, returning to normal by 14 days in the Auto-1 group only. The rate of infectious complications was significantly higher in the Allo than in the Auto group. Blood transfusion is associated with adverse immunologic effects in patients undergoing radical oesophagectomy. However, autologous blood transfusion is favourable compared to allogeneic transfusion. Autologous transfusion programs should be employed when possible in this group of patients.