Association of intraoperative transfusion of blood products with mortality in lung transplant recipients

Abstract

BackgroundThe impact of intraoperative transfusion on postoperative mortality in lung transplant recipients is still elusive.MethodsUnivariate and multivariate analysis were performed to investigate the influence of red blood cells (RBCs) and fresh frozen plasma (FFP) on mortality in 134 consecutive lung transplants recipients from September 2003 until December 2008.ResultsIntraoperative transfusion of RBCs and FFP was associated with a significant increase in mortality with odds ratios (ORs) of 1.10 (1.03 to 1.16, P = 0.02) and 1.09 (1.02 to 1.15, P = 0.03), respectively. For more than four intraoperatively transfused RBCs multivariate analysis showed a hazard ratio for mortality of 3.8 (1.40 to 10.31, P = 0.003). Furthermore, non-survivors showed a significant increase in renal replacement therapy (RRT) (36.6% versus 6.9%, P <0.0001), primary graft dysfunction (PGD) (39.3% versus 5.9%, P <0.0001), postoperative need of extracorporeal membrane oxygenation (ECMO) (26.9% versus 3.1%, P = 0.0019), sepsis (24.2% versus 4.0%, P = 0.0004), multiple organ dysfunction syndrome (MODS) (26.9% versus 3.1%, P <0.0001), infections (18.1% versus 0.9%, P = 0.0004), retransplantation (12.1% versus 6.9%, P = 0.039) and readmission to the ICU (33.3% versus 12.8%, P = 0.024).ConclusionsIntraoperative transfusion is associated with a strong negative influence on outcome in lung transplant recipients.

Lung Transplant With Cardiopulmonary Bypass: Impact of Blood Transfusion on Rejection, Function, and Late Mortality

“…This particular timepoint was chosen to study the effect of blood product transfusion on acute rejection rates. Amounts of RBC, FFP, and platelets transfused for double-lung transplantation with CPB were comparable to other studies [4,14,15]. Our amount and type of blood product transfusion within the first 24 hours of transplantation were not associated with a reduced rate of acute rejection or with the severity of acute rejection episodes.…”

“…For RBC and FFP, there was no statistical significance with mortality outcomes, unlike in the literature [14,16]. Platelets appeared to have a significant adverse effect on early mortality but not late mortality.…”

“…As our acute rejection outcomes for all blood products has remained the same, this finding may be unsurprising. Some studies showed that FFP adversely affects survival outcomes after cardiac surgery but this effect is most likely due to a combination of transfusion-related lung injury and transfusion-associated circulatory overload from the volume effect of the blood product transfusion and its inherent inflammatory nature [13,14]. Our study also showed that longer CPB duration was associated with higher number of RBC, FFP, and platelet transfusions.…”

“…The majority of our blood product transfusions occurred perioperatively, similar to other studies [4,[12][13][14][15][16]. This particular timepoint was chosen to study the effect of blood product transfusion on acute rejection rates.…”

Established and potential predictors of blood loss during lung transplant surgery

“…Examples for the latter are transfusion-associated circulatory overload (TACO) (11), PGD (12) and transfusion-related acute lung injury (TRALI) (13). Nowadays, blood transfusions are acknowledged to prolong hospital stay and increase mortality after lung transplantation (14). In addition, the direct economic effect should not be underestimated as the cost of one unit of packed red blood cells (PRBC) in the United States ranges between US$700-1,200 (15).…”