The effect of male-donor-only fresh frozen plasma on the incidence of acute lung injury following ruptured abdominal aortic aneurysm repair

Introduction

Transfusion-related acute lung injury, due to plasma from female donors containing antileucocyte antibodies, may be a common contributor to the development of acute lung injury (ALI) in the critically ill. In July 2003 the English Blood Service stopped using female donor plasma for the manufacture of fresh frozen plasma (FFP). Patients undergoing repair of ruptured abdominal aortic aneurysm (AAA) receive large amounts of FFP and often develop ALI. We investigated whether the change to male-only FFP was associated with a change in incidence of ALI in patients undergoing emergency AAA repair.

Methods

A before-and-after, observational, single-centre study. Subjects were 211 consecutive patients undergoing open repair of a ruptured AAA between 1998 and 2006. Primary outcome was development of ALI (PaO₂/FiO₂ < 300 and bilateral pulmonary infiltrates on chest X-ray) in the first 6 hours after surgery. Secondary outcomes were time to extubation, and survival at 30 days. Chest X-rays were examined independently by two radiologists who were blinded to the study hypothesis.

Results

One hundred and twenty-nine patients were operated on before and 82 after the change in FFP procurement. Groups were well matched, with respect to age, sex, co-morbidities and severity of illness, and received similar volumes of i.v. fluids and blood products from admission to 6 hours postoperatively (mean units of FFP, 8.6 before and 8.39 after, P = 0.833). The maximum tidal volume, PEEP, and CVP were similar in both groups. Norepinephrine was given to 8.5% of patients in the before group compared with 24.4% after (P = 0.001), otherwise inotrope use was similar. Primary outcome: there was significantly less ALI following the change to male-only FFP (36% before vs 21% after, P = 0.042). Secondary outcomes were not statistically different between groups; however, patients with ALI in either group had a poorer 30-day survival (59% vs 80%, P = 0.005).

Conclusion

Exclusion of female-donor FFP was associated with a statistically significant reduction in the incidence of ALI in patients undergoing repair of a ruptured AAA.