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 Ness, Ognjen Gajic, Rolf D. Hubmayr, Mark R. Looney, Ram M. Kakaiya

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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.

Original languageEnglish (US)
Pages (from-to)2078-2091
Number of pages14
JournalTransfusion
Volume51
Issue number10
DOIs
StatePublished - Oct 1 2011

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ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

Cite this

Kleinman, S. H., Triulzi, D. J., Murphy, E. L., Carey, P. M., Gottschall, J. L., Roback, J. D., Carrick, D., Mathew, S., Wright, D. J., Cable, R., Ness, P., Gajic, O., Hubmayr, R. D., Looney, M. R., & Kakaiya, R. M. (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, 51(10), 2078-2091. https://doi.org/10.1111/j.1537-2995.2011.03120.x