Perioperative Management of Bleeding and Transfusion for Lung Transplantation

Pena, Joseph J.; Bottiger, Brandi; Miltiades, Andrea

doi:10.1177/1089253219869030

Cited by 23 publications

(17 citation statements)

References 70 publications

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“…While immunosuppressive effects of PRBC transfusion were implied by reduced organ rejection after renal transplantation, subsequent studies observed proinflammatory effects and worse outcomes of LUTX in response to large-volume PRBC and platelet transfusion (40)(41)(42). In our study the number of transfused PRBC correlated positively with anti-inflammatory serum IL-10.…”

Section: Discussionsupporting

confidence: 54%

Transient perioperative inflammation following lung transplantation and major thoracic surgery with elective extracorporeal support: a prospective observational study

Veraar¹,

Schwarz²,

Thanner³

et al. 2021

Ann Transl Med

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Background: The clinical relevance of inflammation induced by elective perioperative extracorporeal membrane oxygenation (ECMO) usage as an integral part of modern lung transplantation (LUTX) remains elusive. The aim of this study was to determine the perioperative cytokine response accompanying major thoracic surgery employing different extracorporeal devices comprising ECMO, cardiopulmonary bypass (CPB), or no extracorporeal circulation in relation to inflammation, clinically tangible as increased sequential organ failure assessment (SOFA) score, called SOFA. Methods: In this prospective, observational pilot study 42 consecutive patients with end-stage pulmonary disease undergoing LUTX; 15 patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing pulmonary endarterectomy and 15 patients with lung cancer undergoing major lung resections were analysed. Cytokine serum concentrations and SOFA were determined before, at end of surgery and in the following postoperative days. Results: LUTX on ECMO and pulmonary endarterectomy (PEA) on CPB triggered an immediate increase in cytokine serum concentrations at end of surgery: IL-6: 66-fold and 71-fold, IL-10: 3-fold and 2.5-fold, ST2/IL-33R: 5-fold and 4-fold and SOFA: 10.5±2.8 and 10.7±1.7, that decreased sharply to baseline levels from postoperative day 1-5. Despite low perioperative mortality (3 patients, 4.1%) extremely high SOFA ≥13 was associated with mortality after LUTX. Delta-SOFA distinguished survivors from nonsurvivors: −4.5±3.2 vs. −0.3±1.5 (P=0.001). Increased IL-6 serum concentrations were predictive for increased SOFA (sensitivity: 97%, specificity: 80%). Peak cytokine serum concentrations correlated with ECC duration, maximal lactate, transfusion of red-blood-cells, fresh-frozen-plasma, and catecholamine support.Conclusions: LUTX and PEA on extracorporeal circulation with an excellent outcome triggered an immediate rise and concomitant fall of inflammation as observed in cytokine serum concentrations and SOFA. High absolute SOFA in the presence of an uncomplicated postoperative course may pertain to specific management strategies rather than organ failure.

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Section: Discussionsupporting

confidence: 54%

Transient perioperative inflammation following lung transplantation and major thoracic surgery with elective extracorporeal support: a prospective observational study

Veraar¹,

Schwarz²,

Thanner³

et al. 2021

Ann Transl Med

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“…The majority of patients receive at least three units of red blood cells in the perioperative period. 34 Blood transfusion before lung transplantation is known to be a negative predictive factor and is associated with transfusion-related acute lung injury and transfusion-associated circulatory overload, pneumonia, and Epstein-Barr virus infection. 34,35 Our study had some limitations.…”

Section: Discussionmentioning

confidence: 99%

Panel-Reactive and Donor-Specific Antibodies before Lung Transplantation can Affect Outcomes in Korean Patients Receiving Lung Transplantation

et al. 2020

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Purpose Data on the distribution and impact of panel reactive antibodies (PRA) and donor specific antibodies (DSA) before lung transplantation in Asia, especially multi-center-based data, are limited. This study evaluated the prevalence of and effects of PRA and DSA levels before lung transplantations on outcomes in Korean patients using nationwide multicenter registry data. Materials and Methods This study included 103 patients who received a lung transplant at five tertiary hospitals in South Korea between March 2015 and December 2017. Mortality, primary graft dysfunction (PGD), and bronchiolitis obliterans syndrome (BOS) were evaluated. Results Sixteen patients had class I and/or class II PRAs exceeding 50%. Ten patients (9.7%) had DSAs with a mean fluorescence intensity (MFI) higher than 1000, six of whom had antibodies with a high MFI (≥2000). DSAs with high MFIs were more frequently observed in patients with high-grade PGD (≥2) than in those with no or low-grade (≤1) PGD. In the 47 patients who survived for longer than 9 months and were evaluated for BOS after the transplant, BOS was not related to DSA or PRA levels. One-year mortality was more strongly related to PRA class I exceeding 50% than that under 50% (0% vs. 16.7%, p =0.007). Conclusion Preoperative DSAs and PRAs are related to worse outcomes after lung transplantation. DSAs and PRAs should be considered when selecting lung transplant recipients, and recipients who have preoperative DSAs with high MFI values and high PRA levels should be monitored closely after lung transplantation.

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“…Hemorrhage and coagulopathy are unfortunately not uncommon during LTx, but at the same time, the administration of blood products has been associated with worse outcomes, including an increased risk of primary graft dysfunction (PGD) and mortality. This year, Pena et al 5 published “Perioperative Management of Bleeding and Transfusion for Lung Transplantation,” which provides an excellent review of the perioperative utilization of blood products and factor concentrates during LTx. It includes the risks and benefits of transfusions, and also highlights the tremendous need for further investigation into these areas.…”

Section: Lung Transplantationmentioning

confidence: 99%

The Year 2020 in Review: Noteworthy Literature for Thoracic Transplant Anesthesiologists

Abrams

Wilkey

2021

Semin Cardiothorac Vasc Anesth

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The year 2020 was a monumental year in medicine, and this review focuses on selected articles for cardiothoracic anesthesiologists and perioperative physicians involved in the care of heart and lung transplant patients. In the field of lung transplantation, significant strides were made in our knowledge of risk stratification during the preoperative assessment of potential recipients, perioperative transfusion medicine, and the administration of coagulation factor concentrates. In addition, variations in perioperative management and outcomes between institutions were studied across an assortment of metrics regarding lung transplantation, including case volumes and anesthetic practices. Transitioning to topics in the field of heart transplantation, consideration was given to recipients with adult congenital heart disease, and separately, approaches to expanding the donor pool through donation after circulatory death. With regard to preoperative support, outcomes for the total artificial heart as well as the MitraClip as bridges to transplantation were published.

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Perioperative Management of Bleeding and Transfusion for Lung Transplantation

Cited by 23 publications

References 70 publications

Transient perioperative inflammation following lung transplantation and major thoracic surgery with elective extracorporeal support: a prospective observational study

Transient perioperative inflammation following lung transplantation and major thoracic surgery with elective extracorporeal support: a prospective observational study

Panel-Reactive and Donor-Specific Antibodies before Lung Transplantation can Affect Outcomes in Korean Patients Receiving Lung Transplantation

The Year 2020 in Review: Noteworthy Literature for Thoracic Transplant Anesthesiologists

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