Aprotinin in lung transplantation is associated with an increased incidence of primary graft dysfunction

Marasco, Silvana; Pilcher, David; Oto, Takahiro; Chang, Wenly; Griffiths, Ann; Pellegrino, Vincent; Chan, Justin; Bailey, Michael

doi:10.1016/j.ejcts.2009.08.007

Cited by 4 publications

(8 citation statements)

References 19 publications

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“…Our search did reveal two separate studies by Snyder and Islam that provide insight as to why platelets may be particularly of concern 37,41 . Among other risk factors, Snyder et al.…”

Section: Discussionmentioning

confidence: 97%

“…17 Our search did reveal two separate studies by Snyder and Islam that provide insight as to why platelets may be particularly of concern. 37,41 Among other risk factors, Snyder et al describe the association of platelet transfusions with HLA antibody production. Likewise, Islam et al noted that the platelet transfusion volume was higher in patients who had developed of de novo donor specific antibodies (DSA).…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, Islam et al noted that the platelet transfusion volume was higher in patients who had developed of de novo donor specific antibodies (DSA). 37 The remaining referenced studies in Table 1A employed adjuncts or protocols for the purpose of limiting transfusion. Of historical interest only, Balsara found that the antifibrinolytic, aprotinin, produced a trend towards lower perioperative transfusion needs.…”

Section: Discussionmentioning

confidence: 99%

“…21,33 In nine studies, the primary endpoint was either PGD or risk factors for antibody development (Table 3). [34][35][36][37][38][39][40][41] Of the higher quality studies, three demonstrated an association between red blood cell transfusion (pRBC) and PGD, while two studies found that platelet transfusions were associated with the development of de novo donor specific antibodies (dnDSA) or HLA antibodies posttransplant. 5,34,37,40,41 Two of the remaining small studies assessed the impact of the aprotinin, an antifibrinolytic, on the incidence of PGD.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Blood product transfusion and lung transplant outcomes: A systematic review

Klapper

Ledbetter

Poisson

et al. 2021

Clinical Transplantation

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The perioperative transfusion of blood products has long been linked to development of acute lung injury and associated with mortality across both medical and surgical patient populations. 1,2 The need for blood product transfusion during and after lung transplantation is common and, in many instances, unavoidable. However, this practice may potentially be modifiable. 3 In this systematic review, we explore and summarize what is known regarding the impact of blood product transfusion on outcomes following lung transplantation, highlighting the most recent work in this area. Overall, the majority of the literature consists of single center retrospective analyses or the work of multicenter working groups referencing the same database. In the end, there are a number of remaining questions regarding blood product transfusion and their downstream effects on graft function and survival.

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“…Our search did reveal two separate studies by Snyder and Islam that provide insight as to why platelets may be particularly of concern 37,41 . Among other risk factors, Snyder et al.…”

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Blood product transfusion and lung transplant outcomes: A systematic review

Klapper

Ledbetter

Poisson

et al. 2021

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…Studies have mixed results, showing less PGD, no difference, and more PGD. [62][63][64] At this point, it is unclear what benefit, if any, aprotinin may have. Currently, it is only available in Canada and Europe for coronary artery bypass graft operations, so this question is unlikely to be answered any time soon.…”

Section: Recipient Risk Factorsmentioning

confidence: 99%

Mitigation of Primary Graft Dysfunction in Lung Transplantation: Current Understanding and Hopes for the Future

Wilkey

Abrams

2019

Semin Cardiothorac Vasc Anesth

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Primary graft dysfunction (PGD) is a form of acute lung injury that develops within the first 72 hours after lung transplantation. The overall incidence of PGD is estimated to be around 30%, and the 30-day mortality for grade 3 PGD around 36%. PGD is also associated with the development of bronchiolitis obliterans syndrome, a specific form of chronic lung allograft dysfunction. In this article, we will discuss perioperative strategies for PGD prevention as well as possible future avenues for prevention and treatment.

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Fibrinolysis Inhibitors: Potential Drugs for the Treatment and Prevention of Bleeding

et al. 2019

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Hyperfibrinolytic situations can lead to lifethreatening bleeding, especially during cardiac surgery. The approved antifibrinolytic agents such as tranexamic acid, εaminocaproic acid, 4-aminomethylbenzoic acid, and aprotinin were developed in the 1960s without the structural insight of their respective targets. Crystal structures of the main antifibrinolytic targets, the lysine binding sites on plasminogen's kringle domains, and plasmin's serine protease domain greatly contributed to the structure-based drug design of novel inhibitor classes. Two series of ligands targeting the lysine binding sites have been recently described, which are more potent than the most-widely used antifibrinolytic agent, tranexamic acid. Furthermore, four types of promising active site inhibitors of plasmin have been developed: tranexamic acid conjugates targeting the S1 pocket and primed sites, substrate-analogue linear homopiperidylalanine-containing 4amidinobenzylamide derivatives, macrocyclic inhibitors addressing nonprimed binding regions, and bicyclic 14-mer SFTI-1 analogues blocking both, primed and nonprimed binding sites of plasmin. Furthermore, several allosteric plasmin inhibitors based on heparin mimetics have been developed.

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Aprotinin in lung transplantation is associated with an increased incidence of primary graft dysfunction

Abstract: In conclusion, although the benefits of aprotinin on blood loss are well established, this study does not provide support for the use of aprotinin to reduce PGD in lung transplantation and indicates that aprotinin may in fact have a detrimental effect.

Cited by 4 publications

References 19 publications

Blood product transfusion and lung transplant outcomes: A systematic review

Blood product transfusion and lung transplant outcomes: A systematic review

Mitigation of Primary Graft Dysfunction in Lung Transplantation: Current Understanding and Hopes for the Future

Fibrinolysis Inhibitors: Potential Drugs for the Treatment and Prevention of Bleeding

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