Objective To systematically review the risk factors of transfusion-related acute lung injury (TRALI).

Methods Observational studies on the risk factors of TRALI were retrieved from databases including PubMed, CINAHL, EMBASE, The Cochrane Library, CNKI, WanFang Data, VIP, and CBM from the establishment of the databases to March 2024. Quality assessment of the included studies was conducted. Two researchers independently screened the literatures and extracted data, and Meta-analysis was performed using RevMan 5.3 software.

Results A total of 15 case-control studies and 2 cohort studies were included, involving 9 489 patients. The results of the Meta-analysis showed that: ① Recipient-related factors included the Acute Physiology and Chronic Health Evaluation (APACHE) score (SMD=0.45, 95%CI, 0.09 to 0.80, P=0.01), sepsis (OR=3.01, 95%CI, 1.66 to 5.46, P=0.000 3), liver disease (OR=2.09, 95%CI, 1.25 to 3.50, P=0.005), and cardiopulmonary bypass time (WMD=83.71, 95%CI, 12.00 to 155.42, P=0.002). ② Transfusion-related factors (type/volume) included the volume of plasma (WMD=0.37, 95%CI, 0.23 to 0.51, P < 0.000 01), the volume of plasma from female donors (WMD=0.32, 95%CI, 0.02 to 0.62, P=0.04), fresh frozen plasma (FFP) (OR=2.62, 95%CI, 1.72 to 3.98, P < 0.000 01), the volume of platelets (WMD=0.31, 95%CI, 0.06 to 0.56, P=0.01), and massive transfusion (>10 U within 24 h) (OR=4.40, 95%CI, 2.05 to 9.41, P=0.000 1). ③ Donor-related factors included the content of palmitoyl lysophosphatidylcholine (Lyso-PC 16∶0)/stearoyl lysophosphatidylcholine (LysoPC 18∶0) (WMD=18.78, 95%CI, 4.57 to 33.00, P=0.01), human leukocyte antigen class Ⅰ (HLA Ⅰ) antibodies (OR=13.77, 95%CI, 1.13 to 167.28, P=0.04), and granulocyte antibodies (OR=4.48, 95%CI, 1.54 to 13.04, P=0.006), which were significantly associated with TRALI.

Conclusion The APACHE score, sepsis, liver disease, cardiopulmonary bypass time of recipients, the volume of infused plasma, the volume of plasma from female donors, infused FFP, the volume of infused platelets, massive transfusion, the content of Lyso-PC 16∶0/LysoPC 18∶0 in donations, the presence of HLA Ⅰ antibodies, and the presence of granulocyte antibodies in donations are factors influencing the occurrence of TRALI.