Incidence of alloantibody formation after ABO-D or extended matched red blood cell transfusions: a randomized trial (MATCH study)
Incidence of alloantibody formation after ABO-D or extended matched red blood cell transfusions: a randomized trial (MATCH study)
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DOI：
10.1111/trf.13347
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发表时间：
2016-02-01
期刊：
影响因子：
2.9
通讯作者：
Brand, Anneke
中科院分区：
文献类型：
--
作者：
Schonewille, Henk;Honohan, Aine;Brand, Anneke
背景：大多数偶然输血的患者只接受ABO-D相合的输血，并且高达8%的患者会产生抗体。研究扩展(c、C、E、K、FY(A)、JK(A)和S抗原)配型(EM)和ABO-D配型红细胞(RBC)配型对外科患者首次选择性输血后新的临床相关红细胞抗体形成的影响。主要结果是在输血后7~10天、4~6周和4~6个月的3个随访(FU)样本中检测新形成的热反应临床相关RBC同种异体抗体的发生率。结果共随机抽取853名患者，其中333名患者接受了总计1035个RBC单位的输注。97%的输血患者至少有一份FU样本。在意向处理分析中，155例ABO-D患者中有10例检测到新抗体，178例EM患者中有7例检测到新抗体。按方案分析，190名患者的绝对风险差异(ARD)为5.3%(95%可信区间[CI]，-1.4%至12%)。在138例接受红细胞但不输注血小板(PLT)的患者的事后分析中，ARD显著增加，8.0%(95%CI，0.4-16.0)。结论选择抗原的扩大配型可将外科患者的同种异体免疫风险降低%。只有当患者没有接受伴随的非配型PLT输血时，扩大配型才显得成功。
BACKGROUNDMost incidentally transfused patients receive only ABO-D-compatible transfusions and antibodies are formed in up to 8%. The effect of extended (c, C, E, K, Fy(a), Jk(a), and S antigens) matched (EM) and ABO-D-matched red blood cell (RBC) transfusions on the incidence of new clinically relevant RBC antibody formation after a first elective transfusion event in surgical patients was studied.STUDY DESIGN AND METHODSA multicenter randomized trial was performed in nontransfused patients who were scheduled to experience a single elective transfusion event of maximal 4 RBC units. The primary outcome was the incidence of newly formed warm reacting clinically relevant RBC alloantibodies measured in three follow-up (FU) samples taken at 7 to 10 days, 4 to 6 weeks, and 4 to 6 months posttransfusion.RESULTSA total of 853 patients were randomized, and of these, 333 patients were transfused with a total of 1035 RBC units. At least one FU sample was available from 97% of transfused patients. In intention-to-treat analysis, new antibodies were detected in 10 of 155 ABO-D and seven of 178 EM patients, respectively. Per-protocol analysis including 190 patients showed a nonsignificant absolute risk difference (ARD) of 5.3% (95% confidence interval [CI], -1.4% to 12%) in alloimmunization between study arms. In a post hoc analysis of 138 patients who received RBCs but no platelet (PLT) transfusions the ARD increased to significance, 8.0% (95% CI, 0.4-16.0).CONCLUSIONExtended matching for selected antigens reduced the alloimmunization risk by 64% in surgical patients. Extended matching seems successful only if the patient did not receive accompanying nonmatched PLT transfusions.