Association of Blood Donor Age and Sex With Recipient Survival After Red Blood Cell Transfusion

IMPORTANCE While red blood cells (RBCs) are administered to improve oxygen delivery and patient outcomes, they also have been associated with potential harm. Unlike solid organ transplantation, the clinical consequences of donor characteristics on recipients have not been evaluated in transfusion medicine. OBJECTIVE To analyze the association of RBC donor age and sex with the survival of transfusion recipients. DESIGN, SETTING, AND PARTICIPANTS We established a longitudinal cohort by linking data from a blood collection agency with clinical and administrative data at 4 academic hospitals. MAIN OUTCOMES AND MEASURES Cox proportional hazards regression models were fitted to evaluate the risk of donor age and sex on transfusion recipient survival. RESULTS Between October 25, 2006, and December 31, 2013, a total of 30 503 RBC transfusion recipients received 187 960 RBC transfusions from 80 755 unique blood donors. For recipients receiving an RBC unit from younger donors, the risk of death was increased compared with recipients receiving an RBC unit from a donor 40 to 49.9 years old (adjusted hazard ratio, 1.08; 95% CI, 1.06-1.10; P <.001 for donor age range 17-19.9 years and 1.06; 95% CI, 1.04-1.09; P <.001 for donor age range 20-29.9 years). Receiving an RBC transfusion from a female donor was associated with an 8% statistically significant increased risk of death compared with receiving an RBC transfusion from a male donor (adjusted hazard ratio, 1.08; 95% CI, 1.06-1.09; P <.001). CONCLUSIONS AND RELEVANCE Red blood cell transfusions from younger donors and from female donors were statistically significantly associated with increased mortality. These findings suggest that donor characteristics may affect RBC transfusion outcomes.