The Effects of Allogeneic Blood Transfusion in Hepatic Resection

Argipressin for prevention of blood loss during liver resection: a study protocol for a randomised, placebo-controlled, double-blinded trial (ARG-01)

INTRODUCTION

Liver resection carries a high risk for extensive bleeding and need for blood transfusions, which is associated with significant negative impact on outcome. In malignant disease, the most common indication for surgery, it also includes increased risk for recurrence of cancer. Argipressin decreases liver and portal blood flow and may have the potential to reduce bleeding during liver surgery, although this has not been explored.

METHOD AND ANALYSIS

ARG-01 is a prospective, randomised, placebo-controlled, double-blinded study on 248 patients undergoing liver resection at Sahlgrenska University Hospital, Sweden. Patients will be randomised to one of two parallel groups, infusion of argipressin or normal saline administered peroperatively. The primary endpoint is peroperative blood loss. Secondary outcomes include need for blood transfusion, perioperative variables, length of hospital stay, the inflammatory response, organ damage markers and complications at 30 days.

ETHICS AND DISSEMINATION

The study is enrolling patients since March 2022. The trial is approved by the Swedish Ethical Review Authority (Dnr 2021-03557) and the Swedish Medical Product Agency (Dnr 5.1-2021-90115). Results will be announced at scientific meetings and in international peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, NCT05293041 and EudraCT, 2021-001806-32.

Premature Macrophage Activation by Stored Red Blood Cell Transfusion Halts Liver Regeneration Post-Partial Hepatectomy in Rats

Liver resection is a common treatment for various conditions and often requires blood transfusions to compensate for operative blood loss. As partial hepatectomy (PHx) is frequently performed in patients with a pre-damaged liver, avoiding further injury is of paramount clinical importance. Our aim was to study the impact of red blood cell (RBC) resuscitation on liver regeneration. We assessed the impact of RBC storage time on liver regeneration following 50% PHx in rats and explored possible contributing molecular mechanisms using immunohistochemistry, RNA-Seq, and macrophage depletion. The liver was successfully regenerated after PHx when rats were transfused with fresh RBCs (F-RBCs). However, in rats resuscitated with stored RBCs (S-RBCs), the regeneration process was disrupted, as detected by delayed hepatocyte proliferation and lack of hypertrophy. The delayed regeneration was associated with elevated numbers of hemorrhage-activated liver macrophages (Mhem) secreting HO-1. Depletion of macrophages prior to PHx and transfusion improved the regeneration process. Gene expression profiling revealed alterations in numerous genes belonging to critical pathways, including cell cycle and DNA replication, and genes associated with immune cell activation, such as chemokine signaling and platelet activation and adhesion. Our results implicate activated macrophages in delayed liver regeneration following S-RBC transfusion via HO-1 and PAI-1 overexpression.

Serum Levels of VWF, t-PA, TNF-α, and ICAM-1 in Patients Receiving Hemocoagulase Combined with Platelet-Rich Plasma during Total Hip Replacement

Objectives

This study aimed to investigate the effect of hemocoagulase combined with platelet-rich plasma (PRP) in total hip replacement (THR) on reducing bleeding and improving knee joint function in the patients with osteoarthritis.

Methods

From February 2018 to February 2020, 80 osteoarthritis patients undergoing THR were included in the study, of which 40 cases were treated with PRP and hemocoagulase (test group) in the joint capsule in THR and the other 40 cases received saline and thrombin in the joint capsule after THR (control group). Postoperative drainage and corresponding functional exercise were performed for the two groups 12 hours after operation. The outcome measures including operation time, soft-tissue release, blood routine, drainage volume, perioperative blood loss, postoperative incision inflammation, deep vein thrombosis (DVT), and range of motion (ROM) of the joint were recorded.

Results

The hemoglobin and hematocrit values of the test group on the second postoperative day were significantly higher than those of the control group (P < 0.05). The postoperative drainage volume and perioperative blood loss were significantly lower than those of the control group (P < 0.05). The test group was better than the control group in the ROM of the joint at 7 and 15 days after the operation (P < 0.05). A lower value of prothrombin time and activated partial thromboplastin time was revealed in the test group compared with the control group (P < 0.05). No significant difference in the operation time, intraoperative soft-tissue release, postoperative incision inflammation, incidence of DVT, incidence of deep infection, and ROM at day 90 after THR was found in the two groups (P > 0.05).

Conclusions

The application of hemocoagulase combined with PRP in THR can reduce perioperative blood loss, increase wound healing speed and quality, and improve coagulation and immune function. It is a safe and effective method for the patients with knee osteoarthritis who underwent THR.

Impact of Allogeneic Leukocyte-Depleted Red Blood Cell Transfusion on Inflammatory Response and Blood Coagulation in Patients with Recurrence of Colon Cancer after Operation

Objective

Anemia inevitably affects the survival of cancer patients. In clinical practice, patients with anemia and decreased blood volume are treated by component blood transfusion. Through targeted blood transfusion therapy, the efficacy of blood transfusion treatment can be validly improved, which renders clinical benefits in reducing transfusion-induced adverse reactions (ARs). This research project mainly investigated the impact of allogeneic leukocyte-depleted red blood cell (LDRBC) transfusion on inflammatory response and coagulation status of patients with postoperative recurrence of colon cancer (CC).

Methods

A total of 80 patients with postoperative recurrence of CC admitted to Changzhou Second People's Hospital affiliated to Nanjing Medical University from September 2017 to December 2020 were selected as the study subjects. 36 patients with allogeneic suspended red blood cell (RBC) transfusion were used as the control group (CG), and 44 patients receiving allogeneic LDRBC transfusion served as the observation group (OG). The two groups were compared regarding alterations in pretransfusion and posttransfusion serum inflammatory factors, stress indicators and coagulation function, incidence of ARs, postoperative infection, and average incision healing time.

Results

After blood transfusion, serum tumor necrosis interleukin- (IL-) 6, IL-10, factor-α (TNF-α), and C-reactive protein (CRP) decreased in both cohorts, with lower parameters in CG (P < 0.05); the stress indexes, adrenocortical hormone (ACTH), adrenaline (AD), norepinephrine (NE), and cortisol (Cor) increased, especially in CG (P < 0.05); prothrombin time (PT), thrombin time (TT), and activated partial prothrombin time (APTT) in CG were lower than those in OG, and FIB was higher than that in OG with significant differences between two cohorts (all P < 0.05). The two groups had similar cases of lung infection and wound infection (P > 0.05), but the incision healing time was evidently shorter in OG as compared to CG (9.73 ± 1.86 vs 14.67 ± 2.39 d, P < 0.05). The total incidence of ARs was 16.7% in CG and 6.9% in OG, with no significant difference (P > 0.05).

Conclusions

In the blood transfusion treatment for patients with postoperative recurrence of CC, LDRBC transfusion renders significant clinical benefits, which can effectively improve the coagulation function of patients, reduce stress reaction, and shorten incision healing time without increasing ARs during treatment and postoperative infection rate, which is worth popularizing.