Independent risk factors for an increased incidence of thromboembolism after lung transplantation

Abstract

Background Thromboembolism (TE) after lung transplantation (LTX) is associated with increased morbidity and mortality. The aim of this study is to analyze the incidence and outcome of venous and arterial thromboembolic complications and to identify independent risk factors. Patients and methods We retrospectively analyzed the medical records of 221 patients who underwent LTX at our institution between 2002 and 2021. Statistical analysis was performed using SPSS and GraphPad software. Results 74 LTX recipients (33%) developed TE. The 30-days incidence and 12-months incidence were 12% and 23%, respectively. Nearly half of the patients (48%) developed pulmonary embolism, 10% ischemic stroke. Arterial hypertension (p = 0.006), a body mass index (BMI) > 30 (p = 0.006) and diabetes mellitus (p = 0.041) were independent predictors for TE. Moreover, a BMI of > 25 at the time of transplantation was associated with an increased risk for TE (43% vs. 32%, p = 0.035). At the time of LTX, 65% of the patients were older than 55 years. An age > 55 years also correlated with the incidence of TE (p = 0.037) and these patients had reduced overall post-transplant survival when the event occurred within the first postoperative year (59% vs. 72%, p = 0.028). Conclusions The incidence of TE after LTX is high, especially in lung transplant recipients with a BMI > 25 and an age > 55 years as well as cardiovascular risk factors closely associated with the metabolic syndrome. As these patients comprise a growing recipient fraction, intensified research should focus on the risks and benefits of regular screening or a prolonged TE prophylaxis in these patients. Trial registration number DKRS: 00021501.

Endoscopic Lung Volume Reduction Prior to Lung Transplantation Does Not Increase Postoperative Pulmonary Complications

“…In case of eLVR prior to LTx, the patients are older when joining the waiting list, and relevant comorbidities might develop or even progress. Consequently, postoperative cardiovascular complications, such as myocardial infarction [14] or thromboembolism [15], become more likely.…”

Donor and recipient age matching in lung transplantation: A retrospective study

“…Older age serves as a marker for a complex collection of factors, such as comorbidity profiles and underlying diseases, which potentially increase the morbidity and mortality of postoperative patients [ 10 ]. At the same time, as the age of the recipient increases, the probability of serious postoperative complications such as the development of thromboembolism [ 11 ] and post-transplant lymphoproliferative disorder also increases [ 12 ].…”