Effects of Red-Cell Storage Duration on Patients Undergoing Cardiac Surgery

Journal Wrap | The storage of red-cell unit for more than 2 to 3 days was not associated with an increase in cardiac events, new research suggests.

Steiner and colleagues conducted the Red-Cell Storage Duration Study (RECESS) to assess outcomes for cardiac surgery patients who had received transfused red cells. Participants who were undergoing complex cardiac surgery with planned median sternotomy were randomly assigned—in a 1:1 ratio—leukocyte-reduced red cells stored for 10 days or less or for 21 days or more for any needed intraoperative and/or postoperative transfusions.

The primary endpoint was change in Multiple Organ Dysfunction Score (MODS; range 0 to 24, with higher scores indicating more severe organ dysfunction) from the preoperative score to the highest composite score through day 7 or the time of discharge or death. Of the participants who met the criteria for evaluation, 538 received units stored for a mean duration of 7.8±4.8 days (shorter-term storage), and 560 participants received units stored for a mean duration of 28.3±6.7 days (longer-term storage). No significant difference in the number of red-cell units transfused per patient, the receipt of blood components other than red cells, or the characteristics of the surgical procedures performed, were reported by the researchers.

There was little difference between the two treatment groups: the 7-day change in MODS points was similar for 1,087 participants for whom there was complete data (8.5 for shorter-term storage and 8.7 for longer-term storage), even when restricted to post-transfusion measurements; all-cause mortality was comparable for both groups for 28-day mortality (4.4% for shorter-term storage and 5.3% for longer-term storage). Time of death did not differ considerably; a difference in serious or nonserious negative events related to MedDRA was unremarkable, except that fewer participants in the shorter-term storage group had hyperbilirubinemia. Only the hepatic component of MODS, assessed by means of total serum bilirubin level, differed considerably between the groups.

Of their findings, the authors note that the "estimated between-group difference in the change in MODS was –0.2 points (with a confidence interval of –0.6 to 0.3), which is clearly not a difference of any clinical importance." The study results were published in the New England Journal of Medicine.


  1. Steiner ME, Ness PM, Assmann SF, et al. N Engl J Med. 2015;372:1419-29.

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