Kwon Ji Hye, Han Sangbin, Cho Duck, Spahn Donat R, Ko Justin S, Kim Do Yeon, Jun Joo Hyun, Gwak Mi Sook, Kim Gaab Soo
Department of Anesthesiology and Pain Medicine, Seoul, South Korea.
Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Transfusion. 2018 Nov;58(11):2529-2537. doi: 10.1111/trf.14961. Epub 2018 Oct 9.
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).
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.
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).
No evidence was found that transfusion of old RBCs contributes to death after LDLT.
红细胞（RBC）制品在冷藏2周后特性会发生变化。尚不清楚陈旧红细胞是否会影响肝移植后的死亡率。这项回顾性队列研究旨在评估输注红细胞的年龄与活体肝移植（LDLT）后死亡之间的关联。
在200例接受LDLT的受者中，将118例接受平均储存时间少于10天的红细胞的受者（较短储存组）与82例接受平均储存时间超过14天的红细胞的受者（较长储存组）进行比较。主要排除标准为输注储存时间少于4天的极新鲜红细胞以及较短储存组受者输注陈旧红细胞。主要结局为移植后总体死亡。使用Cox模型进行生存分析。
较短储存组红细胞平均储存时间为7天，较长储存组为17天。较短储存组移植后1年、2年和5年的死亡概率分别为5.1%、7.6%和13.6%，较长储存组分别为6.1%、8.5%和13.5%。单因素分析（风险比[HR] 1.00，95%置信区间[CI]，0.47 - 2.16，p = 0.991）和多因素分析（HR 1.07，95% CI，0.46 - 2.50，p = 0.882）显示两组死亡风险相当。移植物失败风险也相当（HR 1.04，95% CI，0.50 - 2.18，p = 0.916）。较短储存组移植后1年、2年和5年的肝细胞癌复发概率分别为10.8%、15.4%和23.1%，较长储存组分别为11.4%、15.9%和20.7%（HR 0.84，95% CI，0.37 - 1.89，p = 0.670）。在移植物再生/功能、血管/胆道并发症、急性肾损伤、手术部位感染或排斥反应方面未观察到显著差异（p > 0.05）。
未发现证据表明输注陈旧红细胞会导致LDLT后死亡。
