• Marcin J Woźniak, Saqib Qureshi, Nikol Sullo, William Dott, Rebecca Cardigan, Michael Wiltshire, Mintu Nath, Nishith N Patel, Tracy Kumar, Alison H Goodall, and Gavin J Murphy.
• 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.).
• Anesthesiology. 2018 Feb 1; 128 (2): 375-385.

BackgroundWe evaluated the effects of two interventions that modify the red cell storage lesion on kidney and lung injury in experimental models of transfusion.MethodsWhite-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.ResultsTransfusion of 14 day red cells resulted in lung injury (lung injury score vs. sham, mean difference -0.3 (95% CI, -0.6 to -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 to 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.ConclusionsReversal of the red cell storage lesion by rejuvenation reduces transfusion-associated organ injury in swine.

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