The efficacy of exchange transfusion as an adjunct treatment for severe falciparum malaria is controversial. No sufficiently powered, randomized, controlled study has been reported. We analyzed 8 studies that compared survival rates associated with adjunct exchange transfusion with those associated with antimalarial chemo-therapy alone. Exchange transfusion was not associated with a higher survival rate than was antimalarial chemotherapy alone (odds ratio [OR], 1.2; 95 % confidence interval [CI], 0.7–2.1). However, patients who received transfusions had higher levels of parasitemia and more-severe malaria. Sensitivity analysis found that survival rates were higher among patients with partial immunity to malaria (OR, 0.5; 95 % CI, 0.2–1.2) than they were among patients with no immunity (OR, 2.1; 95 % CI, 0.9–4.8;). Exchange transfusion doesPp.007 not appear to increase the survival rate; however, there were significant problems with the comparability of treatment groups in the studies reviewed, and a randomized controlled trial is necessary to determine whether exchange transfusion is beneficial. Severe falciparum malaria is a significant health prob-lem worldwide; case fatality rates are 20%–30%, and the disease claims 11 million lives annually, despite aggressive management with antimalarial drugs and