Abstract 16126: Duration of Red Cell Storage and Acute Kidney and Lung Injury Following Cardiac Surgery
Objective Clinical studies have demonstrated associations between allogenic red blood cell (RBC) transfusion and organ dysfunction in cardiac surgical patients. The aim of this study was to determine whether RBC transfusion has a causal effect on the development of acute kidney injury (AKI) and Transfusion mediated acute lung injury (TRALI) in a large animal experimental model.
Method Adult White-Landrace pigs (50-70kg, n=22) were randomised to either Day 42 or Day 14 RBC transfusion or sham procedure. Endpoints included serial functional and biochemical measures of renal and lung injury and endothelial function. All pigs were recovered for 24 hours prior to organ harvest and histological assessment.
Results Transfused pigs received 500mls (2 units) of cross-matched allogenic leucodepleted RBC stored in SAG-M preservative for either 14 or 42 days. Accumulation of toxic metabolites within the supernatant as well as cellular changes showed considerable homology to those measured in SAG-M stored human RBC units. Day 42 RBC transfusion elicited AKI manifest by an 18% reduction in creatinine clearance, renal endothelial dysfunction manifest by an attenuation of the vasodilatory response to acetylcholine in the renal artery and cortical microvasculature, and medullary hypoxia at 24 hours. This was associated with significant platelet activation and inflammatory cell infiltrate in renal tissue. Administration of Day 14 RBC units prevented AKI by preserving creatinine clearance, renal endothelial function and medullary oxygen tension, and attenuating renal platelet activation and inflammatory cell infiltrate. RBC transfusion did not cause TRALI despite eliciting platelet activation and inflammatory cell infiltrate.
Conclusion RBC storage duration is associated with adverse renal outcomes. Platelet activation represents a potentially novel therapeutic target for the prevention of transfusion mediated organ injury in cardiac surgical patients.
- © 2011 by American Heart Association, Inc.