Intraoperative Red Blood Cell Transfusion Is Associated with Primary Graft Dysfunction After Lung Transplantation

Subramaniam, Kathirvel; Gabriel, L.; Bottiger, Brandi; Warneckie, G.; Mathew, H.; Daoud, D.; Qi, Wei; Villavicencio-Theoduloz, M.; Chandrasekharan, Satish; Machuca, Tiago; Raemdonck, V.D.; Neyrinck, Arne; Toyoda, Yasuhiro; Kashem, Mohammed A.; Huddleston, Stephen J.; Ryssel, N.; Ius, F.; Osho, Asishana A.; Myers, Mark E.; Sanchez, P.G.

doi:10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1785

Cited by 3 publications

(3 citation statements)

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“…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.…”

Section: Transfusions In Lung Transplantationmentioning

confidence: 99%

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

Bottiger,

Klapper,

Fessler

et al. 2024

Anesthesiology

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Section: Transfusions In Lung Transplantationmentioning

confidence: 99%

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

Bottiger,

Klapper,

Fessler

et al. 2024

Anesthesiology

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“…There are ongoing efforts by multicenter registries (e.g., Extracorporeal life support organization registry) to define the relationship between blood transfusions and patient outcomes after LT and these efforts should include all possible variables to improve accuracy. 36 It is also important to appreciate relevant limitations when attempting to implement machine learning techniques. In our case, we were faced with the problem of "class imbalance" since the number of controls was overrepresented in our patient population, which often leads to significant degradation in the performance of the model and is attributed to the original design of such algorithms.…”

Section: Full Sample (Nmentioning

confidence: 99%

Utilization of machine learning to model the effect of blood product transfusion on short‐term lung transplant outcomes

Melnyk

Ryan

et al. 2023

Clinical Transplantation

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The objective of this study was to identify the relationship between blood product transfusion and short‐term morbidity and mortality following lung transplantation utilizing machine learning. Preoperative recipient characterstics, procedural variables, perioperative blood product transfusions, and donor charactersitics were included in the model. The primary composite outcome was occurrence on any of the following six endpoints: mortality during index hospitalization; primary graft dysfunction at 72 h post‐transplant or the need for postoperative circulatory support; neurological complications (seizure, stroke, or major encephalopathy); perioperative acute coronary syndrome or cardiac arrest; and renal dysfunction requiring renal replacement therapy. The cohort included 369 patients, with the composite outcome occurring in 125 cases (33.9%). Elastic net regression analysis identified 11 significant predictors of composite morbidity: higher packed red blood cell, platelet, cryoprecipitate and plasma volume from the critical period, preoperative functional dependence, any preoperative blood transfusion, VV ECMO bridge to transplant, and antifibrinolytic therapy were associated with higher risk of morbidity. Preoperative steroids, taller height, and primary chest closure were protective against composite morbidity.

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“…A multicenter, international extracorporeal life support (ECLS) in LT registry was established in 2017 to identify evolving intraoperative practice patterns in LT and their effect on outcomes. 15,16 The current study uses data from this registry to study the relationship between intraoperative transfusion of PRBCs on PGD and related morbidities after LT.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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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.

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Intraoperative Red Blood Cell Transfusion Is Associated with Primary Graft Dysfunction After Lung Transplantation

Cited by 3 publications

References 0 publications

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

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

Utilization of machine learning to model the effect of blood product transfusion on short‐term lung transplant outcomes

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

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