Abstract
BackgroundBlood transfusion can cause immunosuppression and lead to worse outcomes in patients with digestive tract malignancies; however, the specific mechanism behind this is not completely understood. One theory is that increased numbers of regulatory CD3+CD4+CD25+FOXP3+ T cells (Tregs) and forkhead box protein-3 mRNA (FOXP3) expression in the blood after transfusion contribute to these outcomes. The effect of blood transfusion on immune function in patients with different ABO blood types is variable. This study investigates the effect of intraoperative blood transfusion on the number of Tregs and the expression of FOXP3 in the blood of patients with different ABO blood types and digestive tract malignancies.MethodsPatients with digestive tract malignancies who underwent radical resection and received intraoperative blood transfusion were divided into four groups according to their blood types:blood group A, blood group B, blood group O and blood group AB (n = 20 for each group). Blood was collected from all patients before surgery, immediately after transfusion, 1 day after transfusion, and 5 days after transfusion. The number of Tregs was measured by flow cytometry. The expression of FOXP3 was detected by real time reverse transcription polymerase chain reaction (RT-PCR).ResultsThere was no significant difference in the number of Tregs or expression of FOXP3 mRNA among patients with different blood types before surgery. However, the number of Tregs and the expression of FOXP3 increased after blood transfusion in all blood type groups. This increase was especially evident and statistically significant on the first day after blood transfusion when compared with measures obtained before the surgery. Measures returned to the preoperative level five days after surgery. There were significant differences in the increase of Tregs and expression of FOXP3 among patients with different blood types. The greatest increase was seen in patients with blood group B and the least in blood group A.ConclusionsIntraoperative blood transfusion can lead to an increase in blood Tregs and FOXP3 expression in patients with digestive tract malignancies. Increases were greatest on the first day after surgery and differed among patients with different blood types. Increases were greatest in blood type B and least in blood type A.
Highlights
Blood transfusion can cause immunosuppression and lead to worse outcomes in patients with digestive tract malignancies; the specific mechanism behind this is not completely understood
Intraoperative blood transfusion can lead to an increase in blood Tregs and forkhead box protein-3 mRNA (FOXP3) expression in patients with digestive tract malignancies
Increases were greatest on the first day after surgery and differed among patients with different blood types
Summary
Blood transfusion can cause immunosuppression and lead to worse outcomes in patients with digestive tract malignancies; the specific mechanism behind this is not completely understood. One theory is that increased numbers of regulatory CD3+CD4+CD25+FOXP3+ T cells (Tregs) and forkhead box protein-3 mRNA (FOXP3) expression in the blood after transfusion contribute to these outcomes. This study investigates the effect of intraoperative blood transfusion on the number of Tregs and the expression of FOXP3 in the blood of patients with different ABO blood types and digestive tract malignancies. Blood transfusion has been shown to induce immunosuppression in patients with cancer, expecially digestive tract cancer, increase the risk of postoperative infections including lung and anastomotic infections, increase early recurrence of malignancy and cancer-specific deaths, and reduce survival rates [5,6,7,8]. Previous studies have found that an increase in regulatory T cells (Tregs) and expression of their specific marker forkhead box protein-3 (FOXP3) after allogenic blood transfusion may be one of the mechanisms of immunosuppression [9]. The effect of blood transfusion on Tregs and FOXP3 in patients with digestive tract malignancies is unclear
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