Intraoperative Red Blood Cell Transfusion and Primary Graft Dysfunction After Lung Transplantation

Abstract

Background. In this international, multicenter study of patients undergoing lung transplantation (LT), we explored the association between the amount of intraoperative packed red blood cell (PRBC) transfusion and occurrence of primary graft dysfunction (PGD) and associated outcomes. Methods. The Extracorporeal Life Support in LT Registry includes data on LT recipients from 9 high-volume (>40 transplants/y) transplant centers (2 from Europe, 7 from the United States). Adult patients who underwent bilateral orthotopic lung transplant from January 2016 to January 2020 were included. The primary outcome of interest was the occurrence of grade 3 PGD in the first 72 h after LT. Results. We included 729 patients who underwent bilateral orthotopic lung transplant between January 2016 and November 2020. LT recipient population tertiles based on the amount of intraoperative PRBC transfusion (0, 1–4, and >4 units) were significantly different in terms of diagnosis, age, gender, body mass index, mean pulmonary artery pressure, lung allocation score, hemoglobin, prior chest surgery, preoperative hospitalization, and extracorporeal membrane oxygenation requirement. Inverse probability treatment weighting logistic regression showed that intraoperative PRBC transfusion of >4 units was significantly (P < 0.001) associated with grade 3 PGD within 72 h (odds ratio [95% confidence interval], 2.2 [1.6-3.1]). Inverse probability treatment weighting analysis excluding patients with extracorporeal membrane oxygenation support produced similar findings (odds ratio [95% confidence interval], 2.4 [1.7-3.4], P < 0.001). Conclusions. In this multicenter, international registry study of LT patients, intraoperative transfusion of >4 units of PRBCs was associated with an increased risk of grade 3 PGD within 72 h. Efforts to improve post-LT outcomes should include perioperative blood conservation measures.

Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation

“…Several clinical, transplant, and donor characteristics differed significantly among PMV patients. This group received more red cell transfusions during surgery, associated with a higher risk of PGD [ 38 , 39 ]. In addition, higher mean pulmonary artery pressures and a diagnosis of pulmonary arterial hypertension, well-known risk factors for left ventricular dysfunction following lung transplantation [ 38 , 40 ], as well as a greater proportion of recipients receiving intraoperative ECMO may indicate more severe pulmonary edema, which adversely affects early graft function and delays ventilator weaning and time to extubation [ 3 ].…”

Examining Bleeding Risk, Transfusion-related Complications, and Strategies to Reduce Transfusions in Lung Transplantation

“…The most compelling evidence linking intraoperative transfusion to primary graft dysfunction was published by the multicenter Lung Transplant Outcomes Group (N = 1,255), 12 suggesting that large-volume transfusion of red cells (more than 1 l) and platelets during lung transplantation is independently associated with early graft dysfunction. 11,14 In one multicenter study of 729 registry patients that bled during lung transplantation, those receiving more than 4 units intraoperatively were 2.2 times more likely to have severe allograft injury within 72 h. 15 Seay et al 16 examined transfusion strategies for lung transplantation and identified that patients receiving an increased plasma-to-erythrocyte unit ratio had an associated greater degree of primary graft dysfunction, although patients with increased ratios in this cohort also received a higher total transfusion volume.…”