BLOOD-TRANSFUSION AND BONE ALLOGRAFTS - EFFECT ON INFECTION AND OUTCOME

Intraoperative and postoperative blood replacement have been implicate d in increased rates of wound infection, decreased rates of renal allo graft transplant rejection, and increased rates of local recurrence an d metastasis of certain kinds of tumors, all presumably on the basis o f some alteration in the immune system. Because patients who have bone allograft surgery for tumors often require transfusion and because th e procedure is associated with a high rate of failure (20%), infection (9%-10%), and local recurrence (10% for high grade tumors), the effec t of transfusion (range, 0-4750 ml) was studied for 264 patients who h ad proximal humeral, proximal or distal femoral resections, and massiv e cadaveric allografts but who did not have adjuvant chemotherapy or r adiation. An attempt was made to statistically correlate the tumor and allograft outcome and rate of infection with patient age and gender, anatomic site, diagnosis, stage, type of graft, number of subsequent p rocedures, surgical margins, perioperative transfusions, blood loss, d uration of operative procedures, and number of pregnancies. Of the var iables studied, only blood loss, transfusion, and duration of surgery had an effect on outcome and, more specifically, on infection rate and time to union. No effect was observed on metastasis, recurrence, or t he ultimate outcome of the procedure.