Pro-inflammatory cytokines and complement activation in salvaged blood from abdominal aortic aneurism surgery and total hip replacement surgery

Background: Levels of pro-inflammatory mediators in unwashed salvaged blood from abdominal aortic aneur-ism surgery (AAA) are unknown. We hypothesized that there are higher levels of these mediators in unwashed blood salvaged in AAA surgery compared to hip replacement surgery.Study design and Methods: 10 patients scheduled for AAA surgery (Group A) and 10 patients for total hip re-placement surgery (Group H) were included. Blood samples from the auto-transfusion set were obtained during surgery and arterial samples before, during and 6 hours after surgery. Determination of interleukin (IL)-1, IL-6, IL-8, tumor necrosis factor-α (TNF-α), activated complement 3 (C3a) and high-sensitivity C-reactive protein (CRP) were performed. Salvaged blood was not retransfused.Results: Levels [median (minimum, maximum)] of IL-8 in blood in the salvage system were higher in Group A vs. Group H [215.3 (22.5, 697.2) vs. 35.3 (16.7, 66.6) pg/ml, p=0.002]. Higher levels of IL-6 were also seen in Group A vs. Group H [60.0 (52.6, 62.2) vs. 42.34 (19.4, 62.2) pg/ml, p=0.049]. Levels of IL-6 in blood sampled during surgery were ≈5-fold higher in Group A vs. Group H (p=0.023), whereas ≈70 % higher levels of C3a were observed Group H vs. Group A (p=0.021). Postoperative concentrations of IL-1ß (p=0.002), IL-6 (p=0.001) and IL-8 (0.005) were higher in Group A vs. Group H. Conclusion: Salvaged blood in AAA surgery contains substantially higher levels of pro-inflammatory mediators compared to blood in total hip replacement surgery.