Efficacy of Autologous Blood Transfusion Using Recombinant Human Erythropoietin and Postoperative Cell Mediated Immunity in Patients with Gastrointestinal Cancer

Takahiro Okabayashi¹⁾, Noriaki Tanaka²⁾, Susumu Satomi³⁾, Hiroyoshi Suzuki⁴⁾, Hiroshi Takagi⁵⁾, Toshio Takahashi⁶⁾, Yoichi Saito⁷⁾, Tetsuya Touge⁸⁾, Keizo Sugimachi⁹⁾ and Kunzo Orita¹⁰⁾

EPOGIN autologous blood transfusion study group
1)Department of Surg., Kochi Municipal Central Hospital, 2)First Department of Surg., Okayama University, Medical School, 3)Second Department of Surg., Tohoku University, School of Medicine, 4)Department of Gastroenterological Surg. Gastroenterology Center, Tokyo Women's Medical College, 5)Department of Surg. II, Nagoya University, School of Medicine, 6)First Department of Surg., Kyoto Prefectural University of Medicine, 7)First Department of Surg., Kobe University, School of Medicine, 8)Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 9)Department of Surg. II, Faculty of Medicine, Kyushu University, 10)Hayashibara Biochemical Laboratories

To clarify the efficacy and safety of predeposit autologous blood transfusion (ABT) with concomitant use of recombinant human erythropoietin (rHuEPO) in surgical patients with gastroenterological malignancies, the efficacy was evaluated in terms of observed changes in hemoglobin (Hb) concentration after storage of self-donated autologous blood for elective surgery and the percentage of cases avoiding homologous blood transfusion (HBT). Postoperative changes in values for cellular immunity parameters were compared between the ABT group, HBT group and no transfusion (NT) group.
1. The effectiveness rate, as assessed in terms of the decrease in Hb concentration and the preoperative Hb increase, was 67.2% (43/64 cases) for rHuEPO-treated patients of the ABT group after predeposit of 800 ml of autologous blood and 85.7% (6/7 cases) for those of the ABT group after 1,200ml predeposit. HBT could be avoided in 94.2% of cases (65/69) receiving rHuEPO.
2. Of the cellular immune function parameters assessed for postoperative changes, there was a depression of NK activity at weeks 1-2 postoperatively in all three groups. The depression tended to be reversed by week 3 in the ABT and NT groups, whereas the depression was significantly greater and no such recovery was noted in the HBT group. All other parameters showed similar trends of change in the three groups.
The results suggest a noticeable usefulness of rHuEPO and that autologous blood transfusion is also useful not only for the prevention of adverse reactions to homologous blood transfusion but also for inhibiting postoperative depression of cellular immune function.

Key words
autologous blood transfusion, erythropoietin, immune function, gastroenterological malignancy

Reprint requests
Takahiro Okabayashi Department of Surgery, Kochi Municipal Ceutral Hospital 2-7-33 Sakurai-cho, Kochi, 780-0821 JAPAN

Accepted
May 25, 1999

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