Effect of Intraoperative Red Blood Cell Transfusion on Postoperative Complications After Open Radical Cystectomy: Old Versus Fresh Stored Blood

Lee, Seungjun; Seo, Hyungseok; Kim, Hyun-Chang; Lim, Seon-Min; Yoon, Seo-Yeon; Kim, Hyung Suk; Ku, Ja Hyeon; Park, Hee Pyoung

doi:10.1016/j.clgc.2015.06.002

Cited by 17 publications

(13 citation statements)

References 45 publications

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“…55,56 There may be a doseresponse association operating in that in line with the storage lesion, [14][15][16][17][18][19][20] and that although one unit of older RBCs would not be sufficient to cause adverse outcomes, transfusion of a number of units might. 55,56 This is particularly relevant in regard to the safety of massive transfusions of older RBCs to infants and small children.…”

Section: Strengths and Concerns/limitationsmentioning

confidence: 99%

“…[5][6][7][8][9] Finally, the storage medium could be deleterious by generating superoxides and inflammatory mediators that could result in oxidative damage. [10][11][12][13] Observational studies, [14][15][16][17][18][19][20] although potentially confounded, 21,22 have suggested that these complicated mechanisms, often collectively referred to as "storage lesion," may adversely affect patient-important outcomes including infection, organ failure, hospital stay, and death. [14][15][16][17][18][19][20] Prior evidence on the age of transfused RBCs has been dominated by uncontrolled observational studies that suggest better outcomes with fresher RBCs.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12][13] Observational studies, [14][15][16][17][18][19][20] although potentially confounded, 21,22 have suggested that these complicated mechanisms, often collectively referred to as "storage lesion," may adversely affect patient-important outcomes including infection, organ failure, hospital stay, and death. [14][15][16][17][18][19][20] Prior evidence on the age of transfused RBCs has been dominated by uncontrolled observational studies that suggest better outcomes with fresher RBCs. 23,24 However, a recently published 2015 Cochrane Systematic Review 25 that focused exclusively on 16 randomized controlled trials was equivocal in their findings.…”

Section: Introductionmentioning

confidence: 99%

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Transfusion of fresher vs older red blood cells in hospitalized patients: a systematic review and meta-analysis

Alexander

Barty

Fei

et al. 2016

Blood

102

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The impact of transfusing fresher vs older red blood cells (RBCs) on patientimportant outcomes remains controversial. Two recently published large trials have provided new evidence. We summarized results of randomized trials evaluating the impact of the age of transfused RBCs. We searched MEDLINE, EMBASE, CINAHL, the Cochrane Database for Systematic Reviews, and Cochrane CENTRAL for randomized controlled trials enrolling patients who were transfused fresher vs older RBCs and reported outcomes of death, adverse events, and infection.Independently and in duplicate, reviewers determined eligibility, risk of bias, and abstracted data. We conducted random effects meta-analyses and rated certainty (quality or confidence) of evidence using the GRADE approach.

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Section: Strengths and Concerns/limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transfusion of fresher vs older red blood cells in hospitalized patients: a systematic review and meta-analysis

Alexander

Barty

Fei

et al. 2016

Blood

102

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“…5–8 To date, only one retrospective study addressed the effect of blood storage duration on outcomes following RC. 19 While they found no difference between fresh vs. old blood transfusions, this study was underpowered due to its small sample size and conservative definition of older blood (>14 days). As a result, additional studies to investigate the effect of RBC storage duration on clinical outcomes in RC patients are warranted.…”

Section: Introductionmentioning

confidence: 81%

Longer average blood storage duration is associated with increased risk of infection and overall morbidity following radical cystectomy

Chappidi

Chalfin

Johnson

et al. 2017

Urologic Oncology: Seminars and Original Investigations

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Background Bladder cancer patients undergoing radical cystectomy experience high rates of perioperative blood transfusions and morbidity. The aim of this study was to evaluate the impact of blood storage duration on the risk of adverse perioperative outcomes in this high-risk patient population. Materials and Methods In a retrospective review of radical cystectomy patients from 2010–2014 that received perioperative blood transfusions, the average storage duration for all units transfused was used to classify patients as receiving older blood using three different definitions (≥21 days, ≥28 days, and ≥35 days). Multivariable Poisson regression models were used to determine the adjusted relative risk of perioperative infections and overall morbidity in those given older blood compared to fresher blood. Results A total of 205/451(45%) patients undergoing radical cystectomy received non-irradiated, perioperative blood transfusions. In multivariable modeling, increasing average blood storage duration, as a continuous variable, was associated with an increased risk of infections (RR=1.08 per day, 95%CI 1.01–1.17) and overall morbidity (RR=1.08 per day, 95%CI 1.01–1.15). Furthermore, ≥28 day blood storage (vs. <28) was associated with increased infections (RR=2.69, 95%CI 1.18–6.14) and morbidity (RR=2.54, 95%CI 1.31–4.95), and ≥35 day blood storage (vs. <35) was also associated with increased infections (RR=2.83, 95%CI 1.42–5.66) and morbidity (RR=3.35, 95%CI 1.95–5.77). Conclusions Although blood is stored up to 42 days, storage ≥28 days may expose radical cystectomy patients to increased perioperative infections and overall morbidity compared to storage <28 days. Prospective cohort studies are warranted in cystectomy and other high-risk surgical oncology patients, to better determine the impact of blood storage duration.

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“…Studies demonstrated increased rates of mortality [22][23][24][25][26][27][28], morbidity [29], MOD [22,27,30] and infection [22,31,32] in trauma, cardiac surgery, cardiovascular and ICU patients receiving blood stored for two weeks or more. On the other hand, several other studies were unable to demonstrate that the storage duration of blood components utilised have contributed to adverse patient outcomes [24,[33][34][35][36][37][38][39].…”

Section: Clinical Outcomes Of Prbc Transfusionmentioning

confidence: 99%

Characterisation of dendritic cell immune profile in models of transfusion

Ki¹

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Blood transfusion modulates recipients' immune responses sometimes resulting in poor clinical outcomes. Further, transfusion with blood products at date-of-expiry has been associated with exacerbation of this concerning problem. In-vitro studies have demonstrated exposure to packed red blood cell (PRBC) and platelet products modulate the responses of leukocytes, however, there are limited studies on the impact of transfusion on dendritic cells (DC). Despite DC being central to the immune response, their role in transfusion-related immune modulation remains largely undefined. I hypothesised that exposure to blood components changes DC phenotype and function, which could be one mechanism underpinning transfusion-related immune modulation. The potential for blood components (PRBC, buffy-coat-derived platelet concentrates (PC) and cryopreserved platelets (cryo-PLT)) to modulate responses of myeloid dendritic cells ii whether blood components exposing F-actin for Clec9A ligation were present within the blood product. rhClec9A did not bind fresh or stored PRBC, and this outcome was supported by the lack of detection of F-actin. Although, no binding of rhClec9A to PC or cryo-PLT was demonstrated, F-actin was detected on both types of platelet products. As binding of rhClec9A to PRBC, PC or cryo-PLT was not detected, EDTA blood collection tubes were used for the remainder of the study under the premise that lack of expression of this receptor would not impact on outcomes in my transfusion models.I assessed the impact of fresh and/or stored blood products on mDC and BDCA3 + DC surface antigen and inflammatory profile using a human in-vitro whole blood model of transfusion. In parallel, to model the processes associated with viral or bacterial infection, polyinosinic:polycytidylic acid (polyI:C) or lipopolysaccharide (LPS) was added respectively. Exposure to PRBC and PC predominately suppressed surface antigen expression (CD40, CD80, CD83 and CD86) and inflammatory mediator production (interleukin (IL)-6, IL-8, IL-12, tumour necrosis factor-α and interferon-gamma inducible protein-10 or IL-10) on both DC subsets. These changes were often more evident in the presence of polyI:C and LPS, and when DC were exposed to stored PRBC. Similar modulation was evident for BDCA3 + DC when exposed to cryo-PLT alone and cryo-PLT in the presence of polyI:C and LPS. The impact of blood transfusion on the overall inflammatory response by leukocytes was also examined. The immunomodulatory effect of transfusion in-vitro was more pronounced in the presence of polyI:C and LPS. For PRBC, an additional erythrophagocytosis assay was conducted where the uptake of stored PRBC by mDC and BDCA3 + DC was significantly increased in comparison to fresher PRBC.This study provided the first evidence that exposure of PRBC, PC and cryo-PLT modulates mDC and/or BDCA3 + DC maturation and activation. The changes were more pronounced when modelling processes associated with concurrent viral or bacterial infection.Experimental evidence suggested that mod...

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Effect of Intraoperative Red Blood Cell Transfusion on Postoperative Complications After Open Radical Cystectomy: Old Versus Fresh Stored Blood

Cited by 17 publications

References 45 publications

Transfusion of fresher vs older red blood cells in hospitalized patients: a systematic review and meta-analysis

Transfusion of fresher vs older red blood cells in hospitalized patients: a systematic review and meta-analysis

Longer average blood storage duration is associated with increased risk of infection and overall morbidity following radical cystectomy

Characterisation of dendritic cell immune profile in models of transfusion

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