Transfusion outcomes and clinical safety of ABO-nonidentical platelets transfusion：a systematic review and meta-analysis

BACKGROUND ABO-nonidentical platelets transfusion has been frequently employed to address clinical platelets insufficiencies. The significance of ABO compatibility for platelets transfusion is not clearly defined. This study is aimed to explore the transfusion outcomes and clinical safety of ABO-nonidentical platelets transfusion. STUDY DESIGN AND METHODS A systematic articles search was performed for eligible studies published up to November 30, 2023 through the PubMed, Embase, Cochrane library, Chinese National Knowledge Infrastructure database, Wanfang database and SinMed. Meta-analysis Of Observational Studies in Epidemiology study guidelines for observational studies and Newcastle Ottawa bias scale were implemented to assess studies. Meta-analysis was performed using Manager 5.3. This study is registered with PROSPERO, number CRD42023417824. RESULTS A total of 11 retrospective cohort studies and 7 prospective cohort studies with a sample size of 104359 platelets transfusions were included. There was significant difference in transfusion effectiveness between the ABO-identical and ABO-nonidentical platelets transfusions(RR 1.20,95% CI 1.11-1.38,P<0.00001,I2=21%), also the ABO-identical platelets transfusions showed more platelets increment than ABO-nonidentical ones, but it was not statistically significant(MD 0.34,95% CI -0.01-0.70,P=0.06, I2=0%). Allergy and fever occurred more in ABO-nonidentical platelets transfusions in terms of adverse reactions (RR 0.63,95% CI 0.41-0.96, P=0.03, I2=0%; RR 0.59,95% CI 0.37-0.94, P=0.03, I2=31%). When it comes to the mortality, the ABO-identical platelets transfusions did not statistically improve survival in patients who received multiple platelets transfusions (RR 0.77,95% CI 0.72-0.83, P=0.17, I2=38%) and who only received less than 3 transfusions (RR 0.74,95% CI 0.52-1.06, P=0.10, I2=47%) compared with the ABO-nonidentical platelets transfusions. CONCLUSION In comparison to ABO-identical platelets transfusions, nonidentical platelets transfusions exhibited lower transfusion efficacy. However, the clinical safety between these two groups was similar, which indicated that ABO-nonidentical transfusions are acceptable, albeit inferior to ABO-identical ones.