Exploring donor and product factors and their impact on red cell post-transfusion outcomes

Ning, Shuoyan; Heddle, Nancy M.; Acker, Jason P.

doi:10.1016/j.tmrv.2017.07.006

Cited by 39 publications

(51 citation statements)

References 105 publications

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“…Future studies will be necessary to investigate whether variables such as processing/storage additives may have masked the impact of age of blood on transfusion outcomes in recent randomized clinical trials. This study further stresses the opportunity to further improve standardization of blood product processing 42 and the formulation of storage additives. Finally, this study demonstrates the relevance of metabolomics technologies in transfusion medicine and the potential transformative impact that data generated through this technology can have when correlated with transfusion outcomes, as recommended by recent meetings on the state of science in transfusion medicine sponsored by the National Heart, Lung, and Blood Institute and the Food and Drug Administration.…”

Section: Resultsmentioning

confidence: 83%

“…This observation is relevant in the light of the increased awareness about the role of biological/processing variability across transfused units and their potential impact on transfusion outcomes. 42 …”

Section: Discussionmentioning

confidence: 99%

“…41 The apparent disconnect between studies could possibly in part be explained by the role that biological variability (both of donors and recipients) and processing strategies play on the development of the storage lesion and clinical outcomes. 42 …”

Section: Introductionmentioning

confidence: 99%

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Heterogeneity of blood processing and storage additives in different centers impacts stored red blood cell metabolism as much as storage time: lessons from REDS‐III—Omics

et al. 2018

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Background Biological and technical variability has been increasingly appreciated as a key factor impacting red blood cell (RBC) storability and, potentially, transfusion outcomes. Here we performed metabolomics analyses to investigate the impact of factors other than storage duration on the metabolic phenotypes of stored RBC in a multi-center study. Study design and Methods Within the framework of the REDS-III RBC-Omics study, 13,403 donors were enrolled from four blood centers across the United States and tested for the propensity of their RBCs to hemolyze after 42 days of storage. Extreme hemolyzers were recalled and donated a second unit of blood. Units were stored for 10, 23 and 42 days prior to sample acquisition for metabolomics analyses. Results Unsupervised analyses of metabolomics data from 599 selected samples revealed a strong impact (14.2% of variance) of storage duration on metabolic phenotypes of RBCs. The blood center collecting and processing the units explained an additional 12.2% of the total variance, a difference primarily attributable to the storage additive (AS-1 vs AS-3) used in the different hubs. Samples stored in mannitol-free/citrate-loaded AS-3 were characterized by elevated levels of high-energy compounds, improved glycolysis and glutathione homeostasis. Increased methionine metabolism and activation of the trans-sulfuration pathway was noted in samples processed in the center using AS-1. Conclusion Blood processing impacts the metabolic heterogeneity of stored RBCs from the largest multi-center metabolomics study in transfusion medicine to date. Studies are needed to understand if these metabolic differences influenced by processing/storage strategies impact the effectiveness of transfusions clinically.

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Section: Resultsmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Heterogeneity of blood processing and storage additives in different centers impacts stored red blood cell metabolism as much as storage time: lessons from REDS‐III—Omics

et al. 2018

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“…Of note, the association between the use of older RBCs and posttransplant mortality significantly changed after including fresh RBCs stored for less than 4 days (Fig. S3, available as supporting information in the online version of this paper), indicating the ease with which results can be distorted by key RBC product factors . Finally, an alloantibody test was routine for these units, ruling out the presence of an alloimmunization‐related event.…”

Section: Discussionmentioning

confidence: 99%

“…However, this method should be considered carefully after weighing the expected clinical benefit against the potential for a shortage of RBC products . Perioperative transfusion of fresh RBCs stored for less than 4 days was associated with increased mortality in immunosuppressed liver transplant recipients, in line with evidence demonstrating the risk of blood stored for a short duration . However, the use of old RBCs also carries potential risks because the structure of the RBCs and the biochemical characteristics of the storage medium change significantly after 2 weeks of cold storage, a condition termed the “RBC storage lesion.” Although such changes were found to be associated with vasoconstriction, coagulation disturbance, inflammation, and immunomodulation, the clinical relevance of these changes remains unclear.…”

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confidence: 99%

Longer storage of red blood cells does not affect mortality in transfused liver transplant recipients

Kwon¹,

Han²,

Cho

et al. 2018

Transfusion

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BACKGROUND The characteristics of red blood cell (RBC) products change after 2 weeks of cold storage. It is unclear whether older RBCs affect mortality after liver transplantation. This retrospective cohort study aimed to evaluate the association between the age of transfused RBCs and death after living donor liver transplantation (LDLT). STUDY DESIGN AND METHODS Of 200 recipients who underwent LDLT, 118 who received RBCs with a mean storage duration of less than 10 days (shorter storage group) were compared with 82 with an RBC mean storage duration of more than 14 days (longer storage group). Key exclusion criteria were transfusion of very fresh RBCs stored for less than 4 days and transfusion of old RBCs in recipients of the shorter storage group. The primary outcome was posttransplant overall death. Survival analysis was performed using the Cox model. RESULTS Mean RBC storage duration was 7 days in the shorter storage group and 17 days in the longer storage group. Death probability at 1, 2, and 5 years posttransplant was 5.1%, 7.6%, and 13.6% in the shorter storage group, respectively, and 6.1%, 8.5%, and 13.5% in the longer storage group. Death risk was comparable between the two groups in univariable (hazard ratio [HR] 1.00, 95% confidence interval [CI], 0.47‐2.16, p = 0.991) and multivariable (HR 1.07, 95% CI, 0.46‐2.50, p = 0.882) analyses. Graft failure risk was also comparable (HR 1.04, 95% CI, 0.50‐2.18, p = 0.916). Hepatocellular carcinoma recurrence probability at 1, 2, and 5 years was 10.8%, 15.4%, and 23.1%, respectively, in the shorter storage group and 11.4%, 15.9%, and 20.7% in the longer storage group (HR 0.84, 95% CI, 0.37‐1.89, p = 0.670). No significant differences were observed regarding graft regeneration/function, vascular/biliary complications, acute kidney injury, surgical site infection, or rejection (p > 0.05). CONCLUSIONS No evidence was found that transfusion of old RBCs contributes to death after LDLT.

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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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Exploring donor and product factors and their impact on red cell post-transfusion outcomes

Cited by 39 publications

References 105 publications

Heterogeneity of blood processing and storage additives in different centers impacts stored red blood cell metabolism as much as storage time: lessons from REDS‐III—Omics

Heterogeneity of blood processing and storage additives in different centers impacts stored red blood cell metabolism as much as storage time: lessons from REDS‐III—Omics

Longer storage of red blood cells does not affect mortality in transfused liver transplant recipients

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

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