Effect of perioperative autologous versus allogeneic blood transfusion on the immune system in gastric cancer patients.

BACKGROUND

Allogeneic blood transfusion-induced immunomodulation (TRIM) and its adverse effect on the prognosis of patients treated surgically for cancer remain complex and controversial. However, the potential risk associated with allogeneic blood transfusion has heightened interest in the use of autologous blood transfusion. In the present study, the serum concentrations of neopterin, interferon-gamma (IFN-gamma), T lymphocyte subsets (CD3(+), CD4(+), CD8(+), CD4(+)/CD8(+)) and a possible association between these variables were investigated. The purpose was to further evaluate the effect of autologous versus allogeneic blood transfusion on immunological status in patients undergoing surgery for gastric cancer.

METHODS

Sixty ASA I-II (American Society of Anesthesiologists) patients undergoing elective radical resection for stomach cancer were randomly allocated to receive either allogeneic blood transfusion (n=30) or autologous blood transfusion (n=30). Serum concentrations of the neopterin, IFN-gamma and T lymphocyte subsets in the recipients were measured before induction of anesthesia, after operation, and on the 5th postoperative day.

RESULTS

Both two groups, serum neopterin, IFN-gamma, percentages of T-cell subsets (CD3(+), CD4(+)), and CD4(+)/CD8(+) ratio had significantly decreased after operation, but decreased more significantly in group H (receiving allogeneic blood transfusion) than those in group A (receiving autologous whole blood transfusion) (P<0.05). On the 5th postoperative day, serum neopterin, IFN-gamma, CD3(+), CD4(+) T-cells, and CD4(+)/CD8(+) ratio returned to the baseline values in group A. In contrast, the above remain decreasing in group H, where there were no significant relations between serum neopterin and IFN-gamma.

CONCLUSION

Perioperative surgical trauma and stress have an immunosuppressive impact on gastric cancer patients. Allogeneic blood transfusion exacerbates the impaired immune response. Autologous blood transfusion might be significantly beneficial for immune-compromised patients in the perioperative period, clearly showing its superiority over allogeneic blood transfusion.