Observational studies and systematic reviews have found conflicting results on the association between RBC donor sex and associated transfusion recipient mortality. The double-blind, randomized clinical Trial Assessing Donor Sex on Recipient Mortality (iTADS) recently published in The New England Journal of Medicine found that donor sex did not affect recipient mortality. Briefly, 8719 hospitalized participants (mean age, 66.8 years) were randomized 60:40 to receive either RBCs from male or female donors. Patients were followed for up to two years (mean follow-up 11.2 months), and maintained their trial-group assignment throughout the trial for all subsequent inpatient or outpatient transfusions. The 5190 patients (51.4% female) randomized to receive blood from male donors received a mean of 5.1+8.9 units of RBCs, and the 3529 patients (49.5% female) randomized to receive blood from female donors received a mean of 5.4+10.5 units. No significant difference in mortality was observed between the two groups—1141 patients in the female group and 1712 patients in the male group died (unadjusted hazard ratio for death, 0.97; 95% C.I., 0.90 to 1.05). Further research is needed to clarify the effects of mismatched sex RBC transfusions and better understand how donor characteristics affect transfusion efficacy.
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