Massive Donor Transfusion Increases Recipient Early Mortality after Lung Transplantation

Abstract

transfusion were most commonly younger trauma patients. Following adjustment for confounding variables, massive transfusion was significantly associated with an increased risk in 30-day (OR = 1.41; CI 1.03, 1.92; p-value = .03) and 90-day mortality (OR = 1.36; CI 1.06, 1.73; p-value = .01) but not 1 year mortality (OR = 1.17; CI 0.97, 1.41; p-value = .11). There was no significant difference in length of stay or hospital free days with respect to donor transfusion. Conclusion: Massive donor blood transfusion (> 10 units) increases early mortality after lung transplantation. Conversely, sub-massive donor transfusion does not increase donor risk. The mechanism of increased early mortality in massively transfused donors is unclear but is consistent with increased mortality risk seen with primary graft dysfunction.

Perioperative Management of Bleeding and Transfusion for Lung Transplantation

“…Interestingly, a retrospective review of the United Network of Organ Sharing database by Borders et al 23 in 2016 found that large-volume pRBC transfusion in the donor prior to lung donation was associated with increased early recipient mortality after transplantation. In this review of a total 16 255 donors, 8835 (54%) donors had received at least one RBC transfusion prior to organ procurement.…”

“…Whether this observed increase in early mortality is secondary to PGD, TRALI, or another process is unclear as the diagnosis of PGD was not controlled for in this study, though PGD is believed to be likely given that it is the leading cause of early posttransplant mortality. 23 There are several proposed mechanisms to explain the association between blood product transfusion and subsequent development of PGD. The pathophysiology of PGD appears to be similar to other forms of acute lung injury, and biomarkers that are altered in other pulmonary disease states, acute respiratory distress syndrome, and TRALI are also altered in PGD.…”