Newly Published
Critical Care Medicine  |   November 2017
A Comparison of Red Cell Rejuvenation versus Mechanical Washing for the Prevention of Transfusion-Associated Organ Injury in Swine
Author Notes
  • From the Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester LE3 9QP, United Kingdom (M.J.W., S.Q., N.S., W.D., M.N., T.K., A.H.G., G.J.M.); National Health Service Blood and Transplant, Cambridge CB2 0PT, United Kingdom (R.C., M.W.); and National Heart and Lung Institute, Imperial College London, London W12 0NN, United Kingdom (N.N.P.).
  • Submitted for publication December 26, 2016. Accepted for publication October 2, 2017.
    Submitted for publication December 26, 2016. Accepted for publication October 2, 2017.×
  • Acknowledgments: The authors thank Alan Gray, Ph.D., and Matt Landrigan, Ph.D., (Zimmer Biomet, USA) for providing the Rejuvesol solution free of charge for these experiments.
    Acknowledgments: The authors thank Alan Gray, Ph.D., and Matt Landrigan, Ph.D., (Zimmer Biomet, USA) for providing the Rejuvesol solution free of charge for these experiments.×
  • Research Support: Supported by the British Heart Foundation grant Nos. RG/13/6/29947, CH/12/1/29419, and PG/11/95/29173.
    Research Support: Supported by the British Heart Foundation grant Nos. RG/13/6/29947, CH/12/1/29419, and PG/11/95/29173.×
  • Competing Interests: Professor Murphy; Drs. Woźniak, Cardigan, and Wiltshire; and Tracy Kumar declare that they have received grant funding for a randomized trial of inosine solution treated allogeneic red cells in cardiac surgery patients from Zimmer Biomet, the manufacturer of the inosine solution. The trial will be sponsored by the University of Leicester. The results of the current study have not been influenced by and this report has not been assisted in any way by any representative or employee of Zimmer Biomet. The other authors declare no competing interests.
    Competing Interests: Professor Murphy; Drs. Woźniak, Cardigan, and Wiltshire; and Tracy Kumar declare that they have received grant funding for a randomized trial of inosine solution treated allogeneic red cells in cardiac surgery patients from Zimmer Biomet, the manufacturer of the inosine solution. The trial will be sponsored by the University of Leicester. The results of the current study have not been influenced by and this report has not been assisted in any way by any representative or employee of Zimmer Biomet. The other authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Woźniak: Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Wing, Glenfield General Hospital, Leicester LE3 9QP, United Kingdom. mw299@le.ac.uk. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Critical Care Medicine / Coagulation and Transfusion / Critical Care
Critical Care Medicine   |   November 2017
A Comparison of Red Cell Rejuvenation versus Mechanical Washing for the Prevention of Transfusion-Associated Organ Injury in Swine
Anesthesiology Newly Published on November 16, 2017. doi:10.1097/ALN.0000000000001973
Anesthesiology Newly Published on November 16, 2017. doi:10.1097/ALN.0000000000001973
Abstract

Background: We evaluated the effects of two interventions that modify the red cell storage lesion on kidney and lung injury in experimental models of transfusion.

Methods: White–landrace pigs (n = 32) were allocated to receive sham transfusion (crystalloid), 14-day stored allogeneic red cells, 14-day red cells washed using the red cells washing/salvage system (CATS; Fresenius, Germany), or 14-day red cells rejuvenated using the inosine solution (Rejuvesol solution; Zimmer Biomet, USA) and washed using the CATS device. Functional, biochemical, and histologic markers of organ injury were assessed for up to 24 h posttransfusion.

Results: Transfusion of 14 day red cells resulted in lung injury (lung injury score vs. sham, mean difference −0.3 (95% CIs −0.6, −0.1; P = 0.02), pulmonary endothelial dysfunction, and tissue leukocyte sequestration. Mechanical washing reduced red cell–derived microvesicles but increased cell-free hemoglobin in 14-day red cell units. Transfusion of washed red cells reduced leukocyte sequestration but did not reduce the lung injury score (mean difference −0.2; 95% CI −0.5, 0.1; P = 0.19) relative to 14-day cells. Transfusion of washed red cells also increased endothelial activation and kidney injury. Rejuvenation restored adenosine triphosphate to that of fresh red cells and reduced microvesicle concentrations without increasing cell-free hemoglobin release. Transfusion of rejuvenated red cells reduced plasma cell-free hemoglobin, leukocyte sequestration, and endothelial dysfunction in recipients and reduced lung and kidney injury relative to 14-day or washed 14-day cells.

Conclusions: Reversal of the red cell storage lesion by rejuvenation reduces transfusion-associated organ injury in swine.