Immune modulation and microchimerism after unmodified versus leukoreduced allogeneic red blood cell transfusion in cancer patients: results of a randomized study
BACKGROUND Transfusion of red blood cells (RBCs) has been associated with immunomodulatory effects. Persistence of donor cells in the recipient may be contributive. STUDY DESIGN AND METHODS A randomized single-center trial was conducted to compare microchimerism and immune responses in 35 patients undergoing cancer surgery and transfused perioperatively with either unmodified RBCs (UN-RBCs, n = 18) or leukoreduced RBCs (LR-RBCs, n = 17). Biologic parameters included microchimerism assessment peripheral blood mononuclear cell (PBMNC) phenotyping, cytokine production by stimulated PBMNCs, FoxP3 gene expression, and T-cell repertoire (TCR) analysis. RESULTS Microchimerism was documented in 8 of 18 patients after UN-RBC transfusion while absent after LR-RBC transfusion (0/17; p = 0. 001). After UN-RBC transfusion, microchimerism was associated with increased interleukin (IL)-10 production (p = 0. 02), reduced TCR alteration (p = 0. 04), and reduced CD56+ cell counts (p = 0. 02) when compared to recipients without evidence for microchimerism. FoxP3 gene expression did not differ significantly between both treatment groups nor with the presence or absence of microchimerism in the UN-RBC group. Finally, after an initial early decrease after surgery and transfusion, IL-12 production increased and more significantly so after UN-RBC transfusion versus LR-RBC transfusion (p = 0. 05). CONCLUSION UN-RBC-induced microchimerism is associated with specific immunomodulatory effects in cancer patients who received transfusions during surgery.
Fibrin glue effectiveness and tolerance after elective liver resection: a randomized trial
BACKGROUND/AIMS: The propensity of fibrin glue to achieve ultimate control of the liver raw surface and its tolerance after hepatic resection, were evaluated by a prospective study. MATERIALS AND METHODS Seventy seven patients undergoing elective liver resection for benign lesions (n = 35) and malignant lesions (n = 42) including 7 with cirrhosis were studied. Randomization took place only at peritoneal closure and after completion of hemostasis and biliostasis. RESULTS In the group with fibrin glue (n = 38), a single dose of 5 ml was applied to the liver cut surface. The appearance of the liver margin at abdominal closure was judged as dry in 34/35 (97%) patients with fibrin glue, versus 34/42 (81%) in those without (p = 0.016). Although postoperative morbidity and mortality were not different between the 2 groups, the mean total fluid drainage during the three postoperative days and bilirubin concentration were significantly lower in the group with fibrin glue; respectively 242 +/- 249 ml vs 505 +/- 666 ml and 24 +/- 21 mmoles/l vs 65 +/- 47 mmoles/l. CONCLUSIONS Our results indicate that fibrin glue application to the hepatic stump after hepatic resection provides effective sealing with good systemic and local compatibility.