The role of donor antibodies in the pathogenesis of transfusion-related acute lung injury: a systematic review

BACKGROUND: The majority of cases of transfusion-related acute lung injury (TRALI) are thought to be caused by the presence of leukocyte antibodies in the blood of the donor. We performed a systematic search of the literature to quantify the contribution of donor antibodies to the occurrence of TRALI. STUDY DESIGN AND METHODS: We conducted a systematic search of the PubMed and EMBASE databases. Retrieved articles were judged by three authors independently. Reference lists of all articles were subsequently screened for relevant references. All articles in English, German, French, and Dutch, published at any time before December 2007, were eligible for inclusion. RESULTS: Of 77 articles on leukocyte antibodies in donors involved in a case of TRALI, 14 articles contained sufficient data. These 14 articles reported leukocyte antibodies in 24 of 51 donors (47%) associated with 24 of 28 TRALI cases (86%). Of 15 articles that reported the prevalence of leukocyte antibodies in the general donor population, 2 articles reported a prevalence of 17 percent in (452) randomly selected donors. The odds ratio for developing TRALI was 15 (95% confidence interval [CI], 5.1-45) for patients who received a transfusion from a donor who tested positive for the presence of leukocyte antibodies, compared to donors who tested negative. Leukocyte antibodies contributed to 80 percent (95% CI, 51%-92%) of all TRALI cases. CONCLUSION: Leukocyte antibodies were more prevalent in donors involved in TRALI cases than among randomly selected donors. These findings suggest that donor antibodies contribute to four-fifths of all TRALI cases.