Age of transfused blood in critically ill adult trauma patients: a prespecified nested analysis of the Age of Blood Evaluation randomized trial

Green, Robert S.; Erdoğan, Mete; Lacroix, Jacques; Hébert, Paul C.; Tinmouth, Alan; Sabri, Elham; Zhang, Tinghua; Fergusson, Dean; Turgeon, Alexis F.

doi:10.1111/trf.14640

Cited by 8 publications

(7 citation statements)

References 36 publications

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“…13 Randomized clinical trials published since 2013 revealed similar conclusions. 18,19,[21][22][23] Nevertheless, the Age of Blood Evaluation (ABLE) study 20 suggested a trend toward an increased mortality with fresh RBC units. To our knowledge, no data have been reported in kidney transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Longer storage induces biochemical and morphological modifications of RBC units and accumulation of soluble components that may be deleterious, notably by impairing oxygen delivery to tissues . Consistent with this, some studies suggested that longer RBC storage was associated with worse outcomes in different clinical settings . However, these results have not been consistent, and the benefits of using fresh RBC have been called into question …”

Section: Introductionmentioning

confidence: 97%

“…13,14,16,17 Consistent with this, some studies suggested that longer RBC storage was associated with worse outcomes in different clinical settings. 16,18,19 However, these results have not been consistent, and the benefits of using fresh RBC have been called into question. [20][21][22][23] Indeed, fresh RBC units contain increased quantity of different mediators, including damaged leukocytes and platelets, cell-free DNA, and microvesicles, that can result in inflammation, coagulation, endothelial injury, and organ damage as well.…”

Section: Introductionmentioning

confidence: 99%

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Transfused Red Blood Cell Characteristics and Kidney Transplant Outcomes Among Patients Receiving Early Posttransplant Transfusion

Gaiffe,

Vernerey,

Bardiaux

et al. 2023

JAMA Netw Open

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ImportanceRed blood cell transfusion (RBCT) is frequently required in the early post–kidney transplant period, but long-term outcomes associated with RBCT is controversial. Therefore, it may be relevant to investigate the association between RBCT characteristics and transplant outcomes.ObjectiveTo study the association between RBC storage duration and transplant outcomes.Design, Setting, and ParticipantsThis was a nationwide retrospective cohort study based on data linking between 2 prospective French nationwide registries. Clinical transplant parameters, outcomes, and RBCT characteristics were extracted from the CRISTAL registry of the Agence de la Biomédecine and the national database of the Etablissement Français du Sang. All 12 559 patients having received a first kidney transplant in France between January 1, 2002, and December 31, 2008, were included. Patients were followed up from transplant to graft loss, death with a functional graft, or data retrieval in June 2016. Data were analyzed from April 2019 to June 2022.ExposuresClinical outcomes of transplant recipients who underwent early RBCT were analyzed considering transfusion characteristics.Main Outcomes and MeasuresCox proportional hazards regression models were fitted to evaluate transplant failure defined as graft loss or death with a functional graft.ResultsAmong 12 559 patients who underwent kidney transplant, 3483 received an RBCT during the first 14 days posttransplant. The median (IQR) age of patients was 53.0 (41.5-61.2) years, and 1929 patients (55.4%) were male. Median (IQR) follow-up was 7.8 (7.6-8.0) years. In multivariable analysis, longer (vs shorter) storage duration of transfused RBC was associated with a decrease in risk of transplant failure (hazard ratio, 0.99; 95% CI, 0.98-1.00 for each additional storage day; P = .06). Patients transfused with at least 1 RBC unit stored for more than 20 days had a 5% absolute decrease in transplant failure at 3 years and 7% at 5 years compared with those who received RBC stored for less than 20 days.Conclusions and RelevanceIn this study, longer RBC storage duration was associated with a decreased risk of transplant failure among patients who received kidney transplants and RBC transfusions. Preferential use of RBC with longer storage duration might improve kidney graft survival following transplant and transfusion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Transfused Red Blood Cell Characteristics and Kidney Transplant Outcomes Among Patients Receiving Early Posttransplant Transfusion

Gaiffe,

Vernerey,

Bardiaux

et al. 2023

JAMA Netw Open

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“…First, the new metric is superior to ad hoc dichotomous or ordinal categorizations of numbers of RBCs that then serve as predictors in a model for mortality. For example, unlike the recent nested analysis in the Age of Blood Evaluation RCT that showed no difference in 90‐day mortality risk using dichotomous blood age groups (patients receiving fresh blood [no more than 7 days old] vs. patients with standard‐issue blood), analyses involving SBI do not need to be dichotomized; thus, we can use more information about the blood age distribution than these previous authors. Additionally, because it is a scalar, the SBI makes statistical modeling simpler and its interpretation easier, and it has properties that facilitate receiver operating characteristic (ROC) analysis.…”

Section: Discussionmentioning

confidence: 99%

Characterizing red blood cell age exposure in massive transfusion therapy: the scalar age of blood index (SBI)

et al. 2019

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BACKGROUND: The mortality of trauma patients requiring massive transfusion to treat hemorrhagic shock approaches 17% at 24 hours and 26% at 30 days. The use of stored RBCs is limited to less than 42 days, so older RBCs are delivered first to rapidly bleeding trauma patients. Patients who receive a greater quantity of older RBCs may have a higher risk for mortality. METHODS AND MATERIALS: Characterizing bloodage exposure requires accounting for the age of each RBC unit and the quantity of transfused units. To address this challenge, a novel Scalar Age of Blood Index (SBI) that represents the relative distribution of RBCs received is introduced and applied to a secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) randomized controlled trial (NCT01545232, https://clinicaltrials.gov/ct2/show/ NCT01545232). The effect of the SBI is assessed on the primary PROPPR outcome, 24-hour and 30-day mortality. RESULTS:The distributions of blood storage ages successfully maps to a parameter (SBI) that fully defines the blood age curve for each patient. SBI was a significant predictor of 24-hour and 30-day mortality in an adjusted model that had strong predictive ability (odds ratio, 1.15 [1.01-1.29], p = 0.029, C-statistic, 0.81; odds ratio, 1.14 [1.02-1.28], p = 0.019, C-statistic, 0.88, respectively).CONCLUSION: SBI is a simple scalar metric of blood age that accounts for the relative distribution of RBCs among age categories. Transfusion of older RBCs is associated with 24-hour and 30-day mortality, after adjustment for total units and clinical covariates.T rauma is a leading cause of death and disability in younger adults. 1 Critically ill trauma patients may present with multisystem injury, severe blood loss, and traumatic hemorrhagic shock (THS) requiring emergent blood transfusions, often totaling 10 or more units of RBCs. The mortality of THS is high, approaching 17% at 24 hours and 26% at 30 days. 2 As RBCs age, they undergo biochemical and metabolic changes resulting in hemolysis. [3][4][5] In animal hemorrhage models, transfusion with older RBCs exacerbates impaired coagulation and organ perfusion, increasing susceptibility to infections, inflammation, oxidative stress, organ damage, and death. 6,7 Current practices limit RBC transfusion to units less than 42 days old. However, because of their large blood transfusion requirements, there is strong potential for ABBREVIATIONS: CDF = cumulative distribution function; ISS = Injury Severity Score; NLS = nonlinear least squares; PROPPR = Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial; RCTs = randomized controlled trials; ROC = receiver operating characteristic; RTS = Revised Trauma Score; SBI = Scalar Age of Blood Index; THS = traumatic hemorrhagic shock.From the

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“…Many clinicians would be cautious about extrapolating research findings across different populations or undertaking meta-analysis across different clinical settings 2532. If, as has been hypothesised, red blood cells stored for longer are less effective at improving oxygen transport to tissues, then this may be better tolerated by patients with a greater physiological reserve.…”

Section: Importance Of Case MIXmentioning

confidence: 99%

Can we be certain that storage duration of transfused red blood cells does not affect patient outcomes?

Trivella

Stanworth

Brunskill

et al. 2019

BMJ

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Age of transfused blood in critically ill adult trauma patients: a prespecified nested analysis of the Age of Blood Evaluation randomized trial

Abstract: In critically ill trauma patients, transfusion of fresh blood did not decrease 90-day mortality or secondary outcomes, a finding similar to the overall population of the ABLE trial.

Cited by 8 publications

References 36 publications

Transfused Red Blood Cell Characteristics and Kidney Transplant Outcomes Among Patients Receiving Early Posttransplant Transfusion

Transfused Red Blood Cell Characteristics and Kidney Transplant Outcomes Among Patients Receiving Early Posttransplant Transfusion

Characterizing red blood cell age exposure in massive transfusion therapy: the scalar age of blood index (SBI)

Can we be certain that storage duration of transfused red blood cells does not affect patient outcomes?

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