Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions

Abstract

Debate on appropriate triggers for transfusion of allogeneic blood products and their effects on short- and long-term survival in surgical and critically ill patients continue with no definitive evidence or decisive resolution. Although transfusion-related immune modulation (TRIM) is well established, its influence on immune competence in the recipient and its effects on cancer recurrence after a curative resection remains controversial. An association between perioperative transfusion of allogeneic blood products and risk for recurrence has been shown in colorectal cancer in randomized trials; whether the same is true for other types of cancer remains to be determined. This article focuses on the laboratory, animal, and clinical evidence to date on the mechanistic understanding of inflammatory and immune-modulatory effects of blood products and their significance for recurrence in the cancer surgical patient.

Fig 1

The figure illustrates the interaction between cellular and humoral responses against cancer cells. The cellular immune response is composed of Th1 and Tc1 (anti-tumour) and Th2 and Tc2 (pro-tumoral) lymphocytes. Similarly, the cytokine immune response is accomplished by Th1 (IL-2, IL-12, IFN-γ, and TNF-γ) predominantly antitumour cytokines; in contrast, the Th2 cytokines (IL-4, IL-5, IL-6, and IL-10) have mainly pro-tumour actions.