Valk Sarah J, Caram-Deelder Camila, Groenwold Rolf H H, Evers Dorothea, De Vooght Karen M K, Van de Kerkhof Daan, Wondergem Marielle J, Péquériaux Nathalie C V, Hudig Francisca, Zwaginga Jaap Jan, Middelburg Rutger A, Van der Bom Johanna G
Jon J van Rood Center for Clinical Transfusion Research, Sanquin/LUMC, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden.
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden.
Haematologica. 2024 Aug 1;109(8):2478-2486. doi: 10.3324/haematol.2023.283550.
Previous studies found exposure to red blood cell transfusions from female donors who have been pregnant reduces survival in male patients compared to exposure to male donor products, but evidence is not consistent. We postulate the previously observed association is modified by offspring sex, with an expected increased mortality risk for male patients receiving units from female donors with sons. Here, marginal structural models were used to assess the association between exposure to units from ever-pregnant donors, ever-pregnant donors with sons and ever-pregnant donors with daughters, and mortality. Clinical data were collected on first-ever transfusion recipients in the Netherlands and donor data were supplemented with information about offspring sex and date of birth. In this analysis, 56,825 patients were included, of whom 8,288 died during follow-up. Exposure to red blood cell units from ever-pregnant donors with sons was not associated with increased all-cause mortality risk among male transfusion recipients (hazard ratio [HR]=0.91, 95% confidence interval [CI]: 0.83-1.01). Exposure to ever-pregnant donors, irrespective of offspring sex, was associated with mortality in male patients aged between 18 and 50 years (ever-pregnant donors: HR=1.81, 95% CI: 1.31-2.51) compared to male donor units, but was protective in female patients. This study suggests that the observed increased mortality risk for exposure to red blood cell units from parous female donors does not depend on offspring sex. The increased risk of mortality seen in younger adult male patients is consistent with previous observations, but the underlying biological mechanism could not be identified in this study.
以往研究发现，与接受男性献血者的血液制品相比，接受过妊娠的女性献血者的红细胞输血会降低男性患者的生存率，但证据并不一致。我们推测，先前观察到的关联会因后代性别而改变，预计接受有儿子的女性献血者血液的男性患者死亡风险会增加。在此，我们使用边际结构模型来评估接受过妊娠的献血者、有儿子的接受过妊娠的献血者和有女儿的接受过妊娠的献血者的血液与死亡率之间的关联。收集了荷兰首次输血受者的临床数据，并补充了献血者后代性别和出生日期的信息。在该分析中，纳入了56825名患者，其中8288人在随访期间死亡。接受有儿子的接受过妊娠的献血者的红细胞血液与男性输血受者全因死亡风险增加无关（风险比[HR]=0.91，95%置信区间[CI]：0.83-1.01）。与接受男性献血者的血液相比，接受过妊娠的献血者，无论其后代性别如何，都与18至50岁男性患者的死亡率相关（接受过妊娠的献血者：HR=1.81，95%CI：1.31-2.51），但对女性患者有保护作用。这项研究表明，观察到的接受过妊娠的女性献血者的红细胞血液导致死亡风险增加并不取决于后代性别。年轻成年男性患者中观察到的死亡风险增加与先前的观察结果一致，但本研究无法确定其潜在的生物学机制。
