Objective: The global shortage of blood resources has become a significant concern. This study aimed to assess the effects and feasibility of preoperative autologous blood donation (PABD) in elective on-pump cardiac surgeries. 

Methods: This retrospective single-center study included 219 patients who underwent elective on-pump cardiac surgeries between January 2015 and June 2023. All procedures were performed by a single experienced surgical team. Of these patients, 101 (PABD group) donated autologous blood preoperatively and were compared with the Non-PABD group (n = 118). Using the propensity-score matching (PSM) method, 83 well-matched pairs were yielded based on five variables: gender, age, baseline hemogloin level, left ventricular ejection fraction (LVEF), and EuroscoreII. Transfusion data and perioperative outcomes were retrospectively compared. Multivariate logistic regression analyses were employed to assess the independent impact of PABD on outcome indicators. 

Results: In the propensity-matched cohort, there were significant reductions in allogenic red blood cell (RBC) transfusion in the PABD group, both intraoperatively and postoperatively (p < 0.05). Patients in the PABD group experienced a shorter duration of mechanical ventilation (p < 0.05). There was no significant difference in early mortality (p = 0.613). However, the incidences of hemoglobinuria and acute kidney injury (AKI) were significantly lower in the PABD group (p = 0.016 and p = 0.043, respectively). Furthermore, the use of PABD was identified as an independent protective factor for postoperative AKI odds ratio (OR = 0.204; 95% CI, 0.051–0.816; p = 0.025) and hemoglobinuria (OR = 0.141; 95% CI, 0.027–0.723; p = 0.019). 

Conclusion: The use of PABD in cardiac surgeries is beneficial, reducing allogenic RBC transfusions and certain complications without increasing adverse events.