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A-205
2004 |
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| Association between Length of Storage of Erythrocytes and Postoperative Acute Renal Dysfunction in Patients Undergoing Reoperative Cardiac Surgery | ||||||||||||||||||||
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Sukhjeewan Basran, M.D., Robert J. Frumento, M.P.H., Allison Cohen, B.S., Ervant Nishanian, M.D., Elliott Bennett-Guerrero, M.D. Anesthesiology, Columbia University College of Physicians & Surgeons, New York, New York. |
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Introduction: Acute renal failure (ARF) requiring dialysis occurs in approximately 1-3% of patients after major cardiovascular surgery.1 Acute renal dysfunction (ARD) occurs in approximately 8%.2 The TRICC study raised the possibility that transfusion of stored red cells has adverse effects,3 possibly due to the depletion of red cell 2, 3 DPG and ATP and reduced cell deformability. This storage lesion could impair oxygen delivery to renal tissues. There are few data regarding red cell storage lesions and kidney function. Methods: This was a single-center, retrospective cohort study. Patients undergoing preoperative dialysis or with a preoperative creatinine value ≥ 2 mg/dl were excluded. Transfusion data was collected through postoperative day 7. Variables used for each patient were 1)mean duration of storage of all erythrocytes transfused 2) duration of storage of the oldest unit transfused. The storage time of the newest unit was introduced to the analyses as a surrogate measure for polytransfusion. Acute renal dysfunction was defined as - serum creatinine increase postoperatively to ≥2 mg/dL with an increase of ≥0.7 mg/dL within 2 weeks after surgery OR Need for dialysis within 2 weeks after surgery.2 Results: All of the 434 patients evaluated were reoperations, 94.7% underwent first cardiac reoperation. Three hundred ninety-two patients (90.3%) received allogeneic transfusions of erythrocytes, 220(50.7%) received platelets, and 172(39.6%) received FFP. In transfused patients (n=392), 58(14.8%) patients developed postoperative renal dysfunction. The mean length of storage of all transfused RBCs to each patient was greater among patients developing ARD than in those who did not (table 1). Similarly, the mean length of storage of the oldest and the youngest RBCs transfused and the total number of RBCs transfused was greater among patients developing ARD (table 1). The total number of RBCs and the mean length of storage of all RBCs were tested for entry into a multivariate logisitc regression model predicting the development of ARD. The total number of RBCs transfused was a significant predictor (p=0.009) of postoperative ARD. After adjustment for the total number of RBC transfusions, the mean length of storage of all transfused RBCs to each patient was a significant predictor(p=0.025). Similarly, the mean length of storage of the youngest and the oldest unit were significant predictors of ARD. Conclusion: Patients undergoing cardiac surgical reoperations are at high risk for developing postoperative ARD. We report an association between the length of storage of perioperatively administered RBCs and the frequency of postoperative ARD in this patient population after adjustment for the effects of known confounding variables. Whether this association is causative and independent of unknown factors should be established in prospective randomized trial. 1.Conlon, NephrolDialTransplant,1999,14,1158 2.Mangano,AnnInternMed,1998,128,194 3.Herbert, NewEngJMed,1999,340,409 Anesthesiology 2004; 101: A205 |
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