Transfusion-Induced Immunomodulation Following Cancer Surgery: Fact or Fiction?

Extract

Exposure to a foreign antigen can induce both immune activation and immunosuppression. The immunomodulatory effect of allogeneic transfusions (blood products provided by a donor other than the patient) was first revealed by the positive association between graft survival and the number of allogeneic transfusions received by renal graft recipients (1,2), and this benefit persisted despite the use of the immunosuppressant cyclosporine (3). In patients undergoing surgery for cancer, such a post-transfusional immunomodulation might have detrimental effects by promoting infection, local tumor relapse, or metastasis.

This commentary is a critical review of the literature conducted to determine if the transfusion of blood products during cancer surgery is itself capable of inducing immunosuppression and thereby increasing the risk of postoperative infection and/or tumor relapse and, if so, how this effect can be overcome. In addition, the biologic mechanisms that could contribute to a post-transfusional immunomodulation are reviewed and discussed.

Immunomodulation and Transfusion: Experimental Studies