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

Abstract

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.

Effects of Biopolymers from Cassava Implanted with Rodent Bait on Wistar Rats

“…However, the decrease in the red blood cell counts was not significant. The liver has an important role in the regeneration of red blood cells [26][27][28]. According to Eissa and Zidan [29][30], reduction in red blood cell counts could result from the failure of the liver to supply the blood circulation with cells from haemohepatic tissues and the possible destructive effect on red blood cells by anti-nutrientive factors.…”

Reply: Posthepatic-ischemia-reperfusion injury–related AKI: A need for better biomarkers and interventions to mitigate the risk

“…High AKI risk even after LDLT may suggest hepatic ischemia-reperfusion injury during LDLT is sufficient to develop AKI. [2] On the other hand, DDLT recipients also would be good subjects considering the greater amount of hepatic ischemiareperfusion injury and greater AKI incidence. I agree the association between hepatic ischemia-reperfusion injury, NGAL, and AKI, as well as the mechanisms underlying their association, can be better elucidated if future research focuses on this subgroup of patients undergoing LDLT or DDLT.…”

“…I agree with the authors’ suggestion that living donors would be good subjects for analyzing the association between hepatic ischemia-reperfusion injury and neutrophil gelatinase-associated lipocalin (NGAL) levels; LDLT recipients would be good subjects for the same purpose, while other confounding factors are more standardized. High AKI risk even after LDLT may suggest hepatic ischemia-reperfusion injury during LDLT is sufficient to develop AKI 2 . On the other hand, DDLT recipients also would be good subjects considering the greater amount of hepatic ischemia-reperfusion injury and greater AKI incidence.…”