• Henrik Bjursten, Alain Dardashti, Jonas Björk, Per Wierup, Lars Algotsson, and Per Ederoth.
• Department of Cardiothoracic Surgery, Clinical Sciences, Lund University, Lund, Sweden. Electronic address: henrik.bjursten@med.lu.se.
• J. Thorac. Cardiovasc. Surg. 2016 Jul 1; 152 (1): 223-232.e1.

ObjectiveTo examine the mortality risk of blood transfusions when donor information, postdonation treatment, and a wide selection of risk factors are taken into account.MethodsA retrospective study was performed on 9907 patients who underwent coronary artery bypass grafting and/or aortic valve replacement. Several transfusion-related risk factors, including age of blood products, sex of donor, ABO group, Rh group, posttransfusion treatment, and sex matching, were included in the analysis. A wide selection of preoperative comorbidities were included as well. A Cox proportional hazards analysis was performed to determine significant risk factors. Patients were followed for a period of up to 12 years posttransfusion.ResultsWe found an excess mortality for transfusions of sex-mismatched red blood cells (RBCs) per unit transfused (hazard ratio [HR], 1.083; 95% confidence interval [CI] 1.028-1.140; P = .003). In addition, we found a significant risk during the first year for transfusing 1 to 2 units of non-leukocyte-depleted RBCs (HR, 1.426; 95% CI, 1.004-2.024; P = .047). Transfusion of 1 to 2 units of leukocyte-depleted RBCs was not associated with increased risk (HR, 0.981; 95% CI, 0.866-1.110; P = not significant). The age of blood products was not associated with increased mortality.ConclusionsIn this large retrospective study, transfusion of non-sex-matched RBCs was associated with increased mortality. In addition, in patients receiving small amounts of blood, leukocyte depletion of RBCs had a beneficial effect on patient survival.Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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