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Transfusion-Related Immunomodulation (TRIM): From Renal Allograft Survival to Postoperative Mortality in Cardiac Surgery

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Hematologic Abnormalities and Acute Lung Syndromes

Part of the book series: Respiratory Medicine ((RM))

Abstract

Purported deleterious effects of allogeneic transfusion-related immunomodulation (TRIM) have included increased recurrence of resected malignancies and of postoperative bacterial infections, increased short-term (up to 3-months post-transfusion) mortality from all causes, and activation of endogenous Cytomegalovirus or human immunodeficiency virus infection in transfused compared with untransfused patients. The only established clinical TRIM effect is beneficial: it is the enhanced survival of renal allografts after pretransplant transfusions. However, clinical use of this effect (i.e., administration of deliberate allogeneic, white-cell-reduced pretransplant transfusions to enhance renal allograft survival) is seldom made today. Of the deleterious clinical TRIM effects, which have been investigated in some 200 observational studies and in 20 randomized trials, only increased short-term mortality in cardiac surgery, secondary to non-white-cell-reduced (compared with white-cell-reduced) allogeneic blood transfusion has been consistently documented. Across all available randomized trials in cardiac surgery, there is a 72 % increase in short-term mortality from all causes (p < 0.05), although the mechanism of the effect remains unknown and there is no association with a specific cause of death. Until the effect is disproven or its mechanism is elucidated, all cellular blood components transfused in cardiac surgery should be white-cell-reduced. It is not appropriate to introduce universal white-cell reduction of all transfused cellular blood components for the prevention of TRIM.

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Authors and Affiliations

  1. Formerly, Rita and Taft Schreiber Chair in Transfusion Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Eleftherios C. Vamvakas MD, PhD, MPH

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  1. Eleftherios C. Vamvakas MD, PhD, MPH
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Correspondence to Eleftherios C. Vamvakas MD, PhD, MPH .

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  1. Division of Pulmonary, Allergy, and Critical Care Medicine Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Janet S. Lee

  2. Division of Pulmonary, Allergy, and Critical Care Medicine Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Michael P. Donahoe

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Vamvakas, E.C. (2017). Transfusion-Related Immunomodulation (TRIM): From Renal Allograft Survival to Postoperative Mortality in Cardiac Surgery. In: Lee, J., Donahoe, M. (eds) Hematologic Abnormalities and Acute Lung Syndromes. Respiratory Medicine. Humana Press, Cham. https://doi.org/10.1007/978-3-319-41912-1_13

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  • DOI: https://doi.org/10.1007/978-3-319-41912-1_13

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