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In retrospective studies, perioperative blood transfusions were associated with poor prognosis after surgery for cancer and were a major independent risk factor for postoperative bacterial infection. Leucocyte-depleted, in contrast to buffy-coat-depleted, blood has no immunosuppressive effects in transplantation and so might lack detrimental effects on cancer prognosis and postoperative infections. We studied this hypothesis in a controlled trial by randomly allocating patients to receive either leucocyte-depleted red cells or packed cells without buffy coat when blood was needed. Between 1987 and 1990, 871 eligible patients with colorectal cancer, including 697 patients operated upon with curative intent, were randomised in the 16 participating hospitals. Neither the eligible group nor the curative group showed significant differences between the two trial transfusions in survival, disease-free survival, cancer recurrence rates, or overall infection rates after an average follow-up of 36 months. Patients who had a curative resection and who received blood of any sort had a lower 3-year survival than non-transfused patients (69% vs 81%, p = 0.001) and a higher infection rate (39% vs 24%, p < 0.001). Colorectal cancer recurrence rates, however, were not influenced by blood transfusion (30% vs 26%, p = 0.22). These combined observations confirm the association between blood transfusion and poor patient survival but indicate that the relation is not due to promotion of cancer.

BACKGROUND: Several studies suggest that perioperative blood transfusion is a major independent risk factor for postoperative bacterial infections. Transfusion-induced immunosuppression is thought to mediate this effect. STUDY DESIGN AND METHODS: In a randomized clinical trial comprising 697 patients with colorectal cancer, the relationship between two types of red cell components (buffy coat-depleted packed red cells and white cell-reduced [filtered] packed red cells) and postoperative bacterial infections was analyzed. RESULTS: Both types of red cells appeared to be associated with a greater incidence of postoperative infection than was no transfusion (39 vs. 24%, p

The role of the spleen in the manifestation of the transfusion phenomenon was studied in beagle dogs. Beagles were transfused 3 times with 100 ml blood from different mismatched mongrel dogs, at 4, 3, and 2 weeks before mongrel kidney transplantation or splenectomy. Seven transfused dogs were splenectomized 1 week before transplantation, 9 transfused animals were not splenectomized, and a group of 9 kidney allografted controls was neither transfused nor splenectomized. All recipients were given postoperative immunosuppression, which consisted of azathioprine and prednisolone. As with earlier demonstrations it was found that 3 pretransplant blood transfusions in the nonsplenectomized group led to a significant prolongation of kidney graft survival. All transfused animals survived for more than 3 weeks, a period in which more than 50% of the kidneys in the control group were rejected. Four out of 9 transfused dogs became long-term survivors. In the transfused-splenectomized group, 70% of the recipients rejected their kidney acutely within 3 weeks, and only one animal became a long-term survivor. The absence of a transfusion effect in most of the splenectomized dogs suggests that, under the experimental conditions employed, the spleen plays a crucial role for the induction and manifestation of the transfusion phenomenon.