Is cell salvage safe in liver resection? A pilot study.
OBJECTIVE
To investigate the quality of cell salvaged (CS) blood in patients undergoing hemihepatectomy (study group) and compare it with CS-blood from aortic surgery (control group).


METHODS
Observational study.


METHODS
Operating room in a university hospital.


METHODS
6 patients undergoing hemihepatectomy or aortobifemoral bypass with intraoperative blood loss of more than 800 mL. Samples were drawn from the central venous catheter, from the reservoir of a CS recovery system, and from the processed blood in each patient to determine interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF), complement C3a, and the terminal complement complex C5b-9. Microbiological analysis included colony count after cultivation in aerobic and anaerobic medium as well as enrichment culture for 6 days.


RESULTS
In the hemihepatectomy group, levels of IL-6, C3a, and C5b-9 were significantly higher in the reservoir than in samples obtained from the central venous catheter. After the washing procedure, levels of IL-6, C3a, and C5b-9 were lower in the liver resection group than in each patient's own plasma levels. In all patients undergoing aortobifemoral bypass and in 5 patients undergoing hemihepatectomy, blood samples were sterile or showed growth of commensal skin microflora in low numbers (coagulase-negative staphylococci or propionibacteria). In one patient in the liver resection group, we could not exclude contamination with intestinal flora.


CONCLUSIONS
Cell salvaged blood in liver resection seems to be safe for retransfusion with respect to cytokine release and complement activation, but requires further investigation in regard to bacterial contamination.
Schmidt
Annette
A
Department of Anesthesiology, Johannes Gutenberg-University, Mainz, Germany.
Sues
Harald C
HC
Siegel
Ekkehard
E
Peetz
Dirk
D
Bengtsson
Anders
A
Gervais
Hendrik W
HW
D001424:Bacterial Infections / Q000097:blood; D001804:Blood Transfusion, Autologous; D015926:Complement C3a / Q000032:analysis; D015938:Complement Membrane Attack Complex / Q000032:analysis; D017707:Erythrocyte Transfusion / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D010865:Pilot Projects
D015938:Complement Membrane Attack Complex; D015850:Interleukin-6; D016209:Interleukin-8; C047610:SC5b-9 protein complex; D016753:Interleukin-10; D015926:Complement C3a