Diffusion-limited O2 release in human kidneys perfused with stored blood

A central dogma in physiology is that oxygen release at tissues is not diffusion-limited because gas exchange at capillaries is rapid. This assertion has influenced clinical care, which focuses on optimising oxygen delivery through improving blood flow and oxygen content, rather than oxygen unloading from red blood cells (RBCs). Since storage of blood causes profound changes that slow oxygen release from RBCs, transfusions could compromise tissue respiration. We investigated this in transplant human kidneys normothermically perfused with stored blood. During perfusions, renal respiration was measured from blood gases and RBCs were analysed for oxygen-unloading kinetics. Respiratory rate did not correlate significantly with the standard definition of oxygen delivery based on blood flow and oxygen content. However, a strong correlation was obtained after introducing a factor describing oxygen release from RBCs. Oxygen release to tissues can become diffusion-limited with transfused blood, and therefore the kinetic quality of RBCs should be considered. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by NIHR and UKRI ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The UK National Health Service (NHS) North West Greater Manchester South Research Ethics Committee gave ethical approval for the work (REC ref. 20/NW/0442). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors