title: Cell salvage alters the systemic inflammatory response after off-pump coronary artery bypass grafting surgery.
abstract: BACKGROUND
  Retransfused cardiotomy suction blood contains elevated inflammatory markers and is a bypass independent source of inflammatory mediators. We hypothesized that, during off-pump coronary artery bypass (OPCAB) grafting surgery, avoiding retransfusion of unwashed cardiotomy suction blood would beneficially alter both urinary and plasma cytokine concentrations and be renoprotective.
  
  
  METHODS
  Thirty-seven OPCAB surgery patients were randomly allocated to control (retransfusion of unwashed shed blood) and treatment (retransfusion of washed shed blood or discarding of unwashed blood) groups. Over 72 hours we measured plasma (tumor necrosis factor-alpha [TNF-alpha], interleukin-8, interleukin-6, interleukin-10, TNF soluble receptor-2, and interleukin-1 receptor antagonist) and urinary TNF soluble receptor-2 and interleukin-1 receptor antagonist and markers of renal injury and dysfunction (N-acetyl beta D glucosaminidase and alpha1-microglobulin).
  
  
  RESULTS
  We demonstrated elevated proinflammatory cytokines in cardiotomy suction blood, which were effectively eliminated by cell salvage. After retransfusion, in comparison with controls, the treatment group had reduced plasma TNF soluble receptor-2. As compared with controls, treatment group patients also demonstrated significantly reduced levels of the urinary anti-inflammatory cytokine TNF soluble receptor-2. There were no between group differences in markers of renal injury or dysfunction.
  
  
  CONCLUSIONS
  We have demonstrated that the management of shed mediastinal blood alters perioperative, systemic, plasma and urinary cytokine homeostasis at OPCAB surgery but does not impact on subclinical renal injury or dysfunction in this low risk group of patients.
authors.affiliation: Department of Clinical Anaesthesia, Royal Group of Hospitals Trust, Belfast, Ireland. stephen.allen@royalhospitals.n-i.nhs.uk
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Allen
authors.forename: William T
authors.initials: WT
authors.lastname: McBride
authors.forename: Terence J
authors.initials: TJ
authors.lastname: McMurray
authors.forename: Anne S
authors.initials: AS
authors.lastname: Phillips
authors.forename: S Prasad
authors.initials: SP
authors.lastname: Penugonda
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Campalani
authors.forename: Ian S
authors.initials: IS
authors.lastname: Young
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Armstrong
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D001804:Blood Transfusion, Autologous; D047549:Coronary Artery Bypass, Off-Pump; D016207:Cytokines / Q000097:blood* / Q000652:urine*; D005260:Female; D006706:Homeostasis; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood* / Q000652:urine*; D007674:Kidney Diseases / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D047889:Receptors, Tumor Necrosis Factor, Type II / Q000097:blood / Q000652:urine
chemical_list: D016207:Cytokines; D018836:Inflammation Mediators; D047889:Receptors, Tumor Necrosis Factor, Type II