Biomedical subjects

Theresa A Nester

Publications and source records attributed to Theresa A Nester.

3 recordsLinked to original sources

PubMed2006

The effects of leukoreduced blood transfusion on infection risk following injury: a randomized controlled trial.

Allogeneic blood transfusions in surgical patients have been associated with an increased risk of infectious complications and organ dysfunction. Residual leukocytes contaminating units of packed red blood cells have been incriminated through the induction of anergy and/or a potentiated inflammatory response, leading to the possibility that leukoreduced red blood cell transfusion might mitigate these effects. We set out to evaluate the effect of leukoreduced red cell transfusion on the risk of infections complications in patients requiring transfusion following injury. We conducted a single-center, double-blinded randomized controlled trial of leukoreduced versus standard, nonleukoreduced red blood cell transfusions in injured patients receiving transfusion within 24 hrs of injury. The primary endpoint was infectious complications within 28 days of randomization. Secondary end points were multiple organ failure, length of stay, febrile episodes, and mortality. Two hundred sixty eight subjects were eligible for analysis. Rates of infectious complications were similar in subjects receiving leukoreduced transfusions (30%) or standard transfusions (36%) ([RR], 0.84 [0.55-1.3]) and there was no statistically significant effect of leukoreduced blood transfusion on mortality [RR, 1.20 (0.74-1.9)], febrile episodes [RR, 1.01 (0.89-1.2)], or organ dysfunction scores (5.9 vs. 6.6; P=0.29). Thus, pre-storage leukoreduction of allogeneic red blood cells had a small, but non-significant effect on the rate of infectious complication in this high-risk population requiring transfusion. There was no effect on the rates of febrile episodes, mortality, length of stay, or severity of organ dysfunction.

Adult↗

PubMed2006

Leukoreduction of blood transfusions does not diminish transfusion-associated microchimerism in trauma patients.

BACKGROUND: Transfusion of trauma patients can result in long-term survival of donor white blood cells (WBCs) or "transfusion-associated microchimerism" (TA-MC). The aim was to determine whether leukoreduction of blood transfusions, advocated to reduce the immunomodulatory effect of transfusion, decreases the likelihood of developing TA-MC. STUDY DESIGN AND METHODS: A subgroup of trauma patients from a randomized trial was examined, evaluating the risk of infection following leukoreduced versus nonleukoreduced blood transfusion. Patients' blood was sampled at least 1 month after hospital discharge, and TA-MC was assessed with quantitative allele-specific polymerase chain reaction detection of differences at the HLA-DR locus or a panel of insertion-deletion polymorphism loci distributed throughout the chromosomal complement. At the time of blood sampling, a scripted interview was used to ascertain symptoms suggestive of chronic graft-versus host disease (cGVHD). RESULTS: For 67 patients evaluated, the mean age was 43 +/- 17 years and mean Injury Severity Score was 24 +/- 12. Median time from injury to blood sampling for TA-MC was 240 (interquartile range, 116-360) days. Nine of 32 patients (28%) in the nonleukoreduced transfusion group developed TA-MC compared to 13 of 35 patients (37%) in the leukoreduced group (p = 0.43). Subjects with TA-MC were no more likely than subjects without TA-MC to have at least one symptom suggestive of cGVHD (64% vs. 76%, respectively). CONCLUSIONS: TA-MC seems to be a prevalent condition among injured patients at the second of two regional trauma centers evaluated, suggesting that it is a common phenomenon after transfusion in the setting of injury. Although leukoreduction removes greater than 99.9 percent of donor WBCs, it fails to prevent or even substantially reduce the likelihood of developing TA-MC. TA-MC does not appear to be strongly associated with symptoms suggestive of cGVHD several months after transfusion.

Adult↗

PubMed2006

ABO-incompatible solid-organ transplantation.

To increase transplantation access, particularly in living-donor renal transplantation, efforts have been made to overcome the barrier of ABO incompatibility. In adults, the most successful cases have involved renal transplantation. Although the overall goal of reducing antibodies against donor ABO before and after transplantation is a general principle, the protocols used to accomplish this goal vary. More well-designed, controlled clinical trials are needed to establish optimal peritransplantation management protocols. Incompatible liver transplantation still is viewed as a temporary measure until ABO-compatible transplantation can be performed. ABO-incompatible heart and lung transplantation in adults still is not performed intentionally. In children, particularly those with relatively immature immune systems, ABO-incompatible transplantation generally has more success. The immunologic mechanisms leading to successful transplantation are being elucidated. Accommodation is a process whereby the donor organ may participate in its own survival through a series of protective gene responses, possibly in response to low-level incompatible antibody (HLA and ABO). In infants, spontaneous, acquired B-cell tolerance seems to be a primary mechanism. Peritransplantation therapy might be tailored to invoke specific immune graft-sparing mechanisms. The stage is set to eliminate ABO as a barrier to solid-organ transplantation.

ABO Blood-Group System↗