Recipient clinical risk factors predominate in possible transfusion-related acute lung injury

Background Possible transfusion‐related acute lung injury (pTRALI) cases by definition have a clear temporal relationship to an alternative recipient risk factor for acute respiratory distress syndrome (ARDS). We questioned whether transfusion factors are important for the development of pTRALI. Study Design and Methods In this nested case‐control study, we prospectively identified 145 consecutive patients with pTRALI and randomly selected 163 transfused controls over a 4‐year period at the University of California at San Francisco and the Mayo Clinic (Rochester, Minnesota). Results For pTRALI, we found evidence against transfusion being important: receipt of plasma from female donors (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.29‐2.3; p = 0.70), total number of units transfused (OR, 0.99; 95% CI, 0.89‐1.10; p = 0.86), and number of red blood cell and whole blood units transfused (OR, 0.78; 95% CI, 0.59‐1.03; p = 0.079). In contrast, we found that risk for pTRALI was associated with additional recipient factors: chronic alcohol abuse (OR, 12.5; 95% CI, 2.8‐55; p