The Leukocyte Antibody Prevalence Study-II (LAPS-II)

A retrospective cohort study of transfusion-related acute lung injury in recipients of high-plasma-volume human leukocyte antigen antibody-positive or -negative components

Steven H. Kleinman, Darrell J. Triulzi, Edward L. Murphy, Patricia M. Carey, Jerome L. Gottschall, John D. Roback, Danielle Carrick, Sunitha Mathew, David J. Wright, Ritchard Cable, Paul Michael Ness, Ognjen Gajic, Rolf D. Hubmayr, Mark R. Looney, Ram M. Kakaiya

Research output: Contribution to journalArticle

Abstract

BACKGROUND: We used a multicenter retrospective cohort study design to evaluate whether human leukocyte antigen (HLA) antibody donor screening would reduce the risk of transfusion-related acute lung injury (TRALI) or possible TRALI. STUDY DESIGN AND METHODS: In the Leukocyte Antibody Prevalence Study-II (LAPS-II), we evaluated pulmonary outcomes in recipients of 2596 plasma-rich blood components (transfusable plasma and plateletpheresis) sent to participating hospitals; half of the components were collected from anti-HLA-positive donors (study arm) and half from anti-HLA-negative donors (control arm) matched by sex, parity, and blood center. A staged medical record review process was used. Final recipient diagnosis was based on case review by a blinded expert panel of pulmonary or critical care physicians. RESULTS: TRALI incidence was 0.59% (seven cases) in study arm recipients versus 0.16% (two cases) in control arm recipients for an odds ratio (OR) of 3.6 (95% confidence interval [CI], 0.7-17.4; p = 0.10). For possible TRALI cases (nine study arm, eight control arm), the OR was 1.2 (95% CI, 0.4-3.0; p = 0.81), and for TRALI and possible TRALI aggregated together, it was 1.7 (95% CI, 0.7-3.7; p = 0.24). Transfusion-associated circulatory overload incidence was identical in the two arms (1.17 and 1.22%, respectively; OR, 1.0; p = 1.0). CONCLUSIONS: TRALI incidence in recipients of anti-HLA-positive components was relatively low for a lookback study (1 in 170) and was higher than in the control arm, but did not reach significance. Based on this trend, the data are consistent with the likelihood that TRALI risk is decreased by selecting high-volume plasma components for transfusion from donors at low risk of having HLA antibodies.

Original languageEnglish (US)
Pages (from-to)2078-2091
Number of pages14
JournalTransfusion
Volume51
Issue number10
DOIs
StatePublished - Oct 2011

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Plasma Volume
Acute Lung Injury
HLA Antigens
Leukocytes
Cohort Studies
Retrospective Studies
Cross-Sectional Studies
Antibodies
Odds Ratio
Tissue Donors
Confidence Intervals
Incidence
Plateletpheresis
Donor Selection
Lung
Critical Care
Parity
Medical Records
Physicians

ASJC Scopus subject areas

  • Hematology
  • Immunology
  • Immunology and Allergy

Cite this

The Leukocyte Antibody Prevalence Study-II (LAPS-II) : A retrospective cohort study of transfusion-related acute lung injury in recipients of high-plasma-volume human leukocyte antigen antibody-positive or -negative components. / Kleinman, Steven H.; Triulzi, Darrell J.; Murphy, Edward L.; Carey, Patricia M.; Gottschall, Jerome L.; Roback, John D.; Carrick, Danielle; Mathew, Sunitha; Wright, David J.; Cable, Ritchard; Ness, Paul Michael; Gajic, Ognjen; Hubmayr, Rolf D.; Looney, Mark R.; Kakaiya, Ram M.

In: Transfusion, Vol. 51, No. 10, 10.2011, p. 2078-2091.

Research output: Contribution to journalArticle

Kleinman, SH, Triulzi, DJ, Murphy, EL, Carey, PM, Gottschall, JL, Roback, JD, Carrick, D, Mathew, S, Wright, DJ, Cable, R, Ness, PM, Gajic, O, Hubmayr, RD, Looney, MR & Kakaiya, RM 2011, 'The Leukocyte Antibody Prevalence Study-II (LAPS-II): A retrospective cohort study of transfusion-related acute lung injury in recipients of high-plasma-volume human leukocyte antigen antibody-positive or -negative components', Transfusion, vol. 51, no. 10, pp. 2078-2091. https://doi.org/10.1111/j.1537-2995.2011.03120.x
Kleinman, Steven H. ; Triulzi, Darrell J. ; Murphy, Edward L. ; Carey, Patricia M. ; Gottschall, Jerome L. ; Roback, John D. ; Carrick, Danielle ; Mathew, Sunitha ; Wright, David J. ; Cable, Ritchard ; Ness, Paul Michael ; Gajic, Ognjen ; Hubmayr, Rolf D. ; Looney, Mark R. ; Kakaiya, Ram M. / The Leukocyte Antibody Prevalence Study-II (LAPS-II) : A retrospective cohort study of transfusion-related acute lung injury in recipients of high-plasma-volume human leukocyte antigen antibody-positive or -negative components. In: Transfusion. 2011 ; Vol. 51, No. 10. pp. 2078-2091.
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abstract = "BACKGROUND: We used a multicenter retrospective cohort study design to evaluate whether human leukocyte antigen (HLA) antibody donor screening would reduce the risk of transfusion-related acute lung injury (TRALI) or possible TRALI. STUDY DESIGN AND METHODS: In the Leukocyte Antibody Prevalence Study-II (LAPS-II), we evaluated pulmonary outcomes in recipients of 2596 plasma-rich blood components (transfusable plasma and plateletpheresis) sent to participating hospitals; half of the components were collected from anti-HLA-positive donors (study arm) and half from anti-HLA-negative donors (control arm) matched by sex, parity, and blood center. A staged medical record review process was used. Final recipient diagnosis was based on case review by a blinded expert panel of pulmonary or critical care physicians. RESULTS: TRALI incidence was 0.59{\%} (seven cases) in study arm recipients versus 0.16{\%} (two cases) in control arm recipients for an odds ratio (OR) of 3.6 (95{\%} confidence interval [CI], 0.7-17.4; p = 0.10). For possible TRALI cases (nine study arm, eight control arm), the OR was 1.2 (95{\%} CI, 0.4-3.0; p = 0.81), and for TRALI and possible TRALI aggregated together, it was 1.7 (95{\%} CI, 0.7-3.7; p = 0.24). Transfusion-associated circulatory overload incidence was identical in the two arms (1.17 and 1.22{\%}, respectively; OR, 1.0; p = 1.0). CONCLUSIONS: TRALI incidence in recipients of anti-HLA-positive components was relatively low for a lookback study (1 in 170) and was higher than in the control arm, but did not reach significance. Based on this trend, the data are consistent with the likelihood that TRALI risk is decreased by selecting high-volume plasma components for transfusion from donors at low risk of having HLA antibodies.",
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T1 - The Leukocyte Antibody Prevalence Study-II (LAPS-II)

T2 - A retrospective cohort study of transfusion-related acute lung injury in recipients of high-plasma-volume human leukocyte antigen antibody-positive or -negative components

AU - Kleinman, Steven H.

AU - Triulzi, Darrell J.

AU - Murphy, Edward L.

AU - Carey, Patricia M.

AU - Gottschall, Jerome L.

AU - Roback, John D.

AU - Carrick, Danielle

AU - Mathew, Sunitha

AU - Wright, David J.

AU - Cable, Ritchard

AU - Ness, Paul Michael

AU - Gajic, Ognjen

AU - Hubmayr, Rolf D.

AU - Looney, Mark R.

AU - Kakaiya, Ram M.

PY - 2011/10

Y1 - 2011/10

N2 - BACKGROUND: We used a multicenter retrospective cohort study design to evaluate whether human leukocyte antigen (HLA) antibody donor screening would reduce the risk of transfusion-related acute lung injury (TRALI) or possible TRALI. STUDY DESIGN AND METHODS: In the Leukocyte Antibody Prevalence Study-II (LAPS-II), we evaluated pulmonary outcomes in recipients of 2596 plasma-rich blood components (transfusable plasma and plateletpheresis) sent to participating hospitals; half of the components were collected from anti-HLA-positive donors (study arm) and half from anti-HLA-negative donors (control arm) matched by sex, parity, and blood center. A staged medical record review process was used. Final recipient diagnosis was based on case review by a blinded expert panel of pulmonary or critical care physicians. RESULTS: TRALI incidence was 0.59% (seven cases) in study arm recipients versus 0.16% (two cases) in control arm recipients for an odds ratio (OR) of 3.6 (95% confidence interval [CI], 0.7-17.4; p = 0.10). For possible TRALI cases (nine study arm, eight control arm), the OR was 1.2 (95% CI, 0.4-3.0; p = 0.81), and for TRALI and possible TRALI aggregated together, it was 1.7 (95% CI, 0.7-3.7; p = 0.24). Transfusion-associated circulatory overload incidence was identical in the two arms (1.17 and 1.22%, respectively; OR, 1.0; p = 1.0). CONCLUSIONS: TRALI incidence in recipients of anti-HLA-positive components was relatively low for a lookback study (1 in 170) and was higher than in the control arm, but did not reach significance. Based on this trend, the data are consistent with the likelihood that TRALI risk is decreased by selecting high-volume plasma components for transfusion from donors at low risk of having HLA antibodies.

AB - BACKGROUND: We used a multicenter retrospective cohort study design to evaluate whether human leukocyte antigen (HLA) antibody donor screening would reduce the risk of transfusion-related acute lung injury (TRALI) or possible TRALI. STUDY DESIGN AND METHODS: In the Leukocyte Antibody Prevalence Study-II (LAPS-II), we evaluated pulmonary outcomes in recipients of 2596 plasma-rich blood components (transfusable plasma and plateletpheresis) sent to participating hospitals; half of the components were collected from anti-HLA-positive donors (study arm) and half from anti-HLA-negative donors (control arm) matched by sex, parity, and blood center. A staged medical record review process was used. Final recipient diagnosis was based on case review by a blinded expert panel of pulmonary or critical care physicians. RESULTS: TRALI incidence was 0.59% (seven cases) in study arm recipients versus 0.16% (two cases) in control arm recipients for an odds ratio (OR) of 3.6 (95% confidence interval [CI], 0.7-17.4; p = 0.10). For possible TRALI cases (nine study arm, eight control arm), the OR was 1.2 (95% CI, 0.4-3.0; p = 0.81), and for TRALI and possible TRALI aggregated together, it was 1.7 (95% CI, 0.7-3.7; p = 0.24). Transfusion-associated circulatory overload incidence was identical in the two arms (1.17 and 1.22%, respectively; OR, 1.0; p = 1.0). CONCLUSIONS: TRALI incidence in recipients of anti-HLA-positive components was relatively low for a lookback study (1 in 170) and was higher than in the control arm, but did not reach significance. Based on this trend, the data are consistent with the likelihood that TRALI risk is decreased by selecting high-volume plasma components for transfusion from donors at low risk of having HLA antibodies.

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