Departments of General Anesthesiology, Cleveland Clinic, Cleveland, OH; Outcomes Research, Cleveland Clinic, Cleveland, OH.
Liver Transpl. 2013 Nov;19(11):1181-8. doi: 10.1002/lt.23695. Epub 2013 Sep 14.
Investigations have demonstrated conflicting results regarding the influence of the red blood cell (RBC) storage duration on outcomes. We evaluated whether graft failure or mortality after orthotopic liver transplantation (OLT) increased when recipients were transfused with older RBCs. This study included 637 patients who underwent OLT between January 2001 and June 2011. Baseline and perioperative data were obtained from our blood bank, the Unified Transplant Center database, and the United Network for Organ Sharing database. Recipients whose transfused RBCs were all stored for ≤ 15 days were grouped in a younger group, and recipients who were transfused with RBCs stored for >15 days were placed in an older group. The relationship between graft survival/mortality and the age of intraoperatively transfused RBCs was studied by Kaplan-Meier estimation with a log-rank test and multivariate Cox proportional hazards regression. Three hundred thirty-four patients and 303 patients were grouped in the younger and the older RBC groups, respectively, on the basis of the ages of intraoperatively transfused RBCs. Kaplan-Meier estimates of graft survival/mortality as a function of the posttransplant time were significantly different: the older group experienced the outcome sooner than the younger group [P = 0.02 (log-rank test)]. After covariate adjustments, the risk of graft failure/mortality was significantly different at any given time after transplantation between patients receiving intraoperative transfusions of older RBC units and patients receiving intraoperative transfusions of younger RBC units (hazard ratio = 1.65, 95% confidence interval = 1.18-2.31). In conclusion, patients who received intraoperative transfusions of RBCs with longer storage times had an increased risk of adverse outcomes.
研究表明，红细胞（RBC）储存时间对结局的影响结果存在矛盾。我们评估了接受陈旧 RBC 输血的患者在原位肝移植（OLT）后发生移植物失功或死亡的风险是否增加。本研究纳入了 2001 年 1 月至 2011 年 6 月期间接受 OLT 的 637 例患者。基线和围手术期数据来自我们的血库、统一移植中心数据库和器官共享联合网络数据库。将输注的 RBC 全部储存时间≤15 天的患者分为年轻组，输注储存时间>15 天的 RBC 的患者分为陈旧组。通过 Kaplan-Meier 估计和对数秩检验以及多变量 Cox 比例风险回归来研究移植物存活率/死亡率与术中输注 RBC 年龄之间的关系。根据术中输注 RBC 的年龄，334 例患者和 303 例患者分别分为年轻组和陈旧组。移植后时间作为移植物存活率/死亡率的函数的 Kaplan-Meier 估计值差异有统计学意义：陈旧组比年轻组更早出现结局（P=0.02[对数秩检验]）。在调整协变量后，在移植后任何给定时间，接受陈旧 RBC 单位术中输血的患者与接受年轻 RBC 单位术中输血的患者的移植物失功/死亡率风险差异均有统计学意义（风险比=1.65，95%置信区间=1.18-2.31）。总之，接受储存时间较长的 RBC 术中输血的患者发生不良结局的风险增加。
