Transfusion-Related Acute Lung Injury (TRALI) risk reduction measures & the impact on preventing TRALI: systematic review and meta analysis

Background Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related morbidity and mortality. Efforts to reduce TRALI incidence primarily relied on preventive strategies, including male-only or predominantly-male only donor policy for plasma-containing transfusion components. We conducted a systematic review and meta-analysis to assess the effectiveness of TRALI risk reduction measures for preventing TRALI and related-mortality. Study design and Methods We searched MEDLINE, EMBASE, and Cochrane library of observational and interventional studies from January 1, 2000, through January 1, 2020. Primary and secondary outcome measures were the onset of TRALI and the 30-day mortality among TRALI patients, respectively. Results Fifteen articles were included. Using a random-effects model, meta-analysis based on studies involving only fresh frozen plasma (FFP) suggested a significant reduction for TRALI risk after intervention of male-only plasma donor policy (relative risk [RR], 0.28; 95% confident interval [CI], 0.21-0.38). Pooled data of all studies showed a tendency toward reduced 30-day mortality among TRALI patients in male-only plasma group (RR, 0.71; 95% CI, 0.54-0.94). Conclusion The implementation of TRALI risk reduction strategy, male-only or predominantly male-only donor transfusion policy, results in a reduction of TRALI incidence, and possibly mortality.