Risk factors for early bleeding complications after lung transplantation – a retrospective cohort study

Abstract

Risk factors for early bleeding complications after lung transplantation are not well described. Our aim was to evaluate coagulation test results and the use of extracorporeal membrane oxygenation as risk factors for bleeding after lung transplantation. We analyzed a single-center cohort of bilateral lung transplants between January 2009 and August 2015. Predictors of severe postoperative bleeding (bleeding requiring reoperation within 48 h of transplantation) were assessed using multivariable logistic regression. The effect of bleeding on survival was assessed using a Cox proportionalhazards model. Twenty-nine (4.5%) of 641 patients experienced severe postoperative bleeding. Postoperative fibrinogen levels (OR = 0.99, 95% CI 0.98-0.995, P = 0.001; per mg/dl increase) and pre-and postoperative use of extracorporeal membrane oxygenation (OR = 14.41% 95% CI 5.4-40.19, P < 0.001 and OR = 4.25, 95% CI 1.0-11.09, P = 0.002, respectively) were associated with an increased risk of severe postoperative bleeding. Severe postoperative bleeding was associated with decreased survival within 60 days after transplantation (adjusted HR = 5.73, 95% CI 2.52-13.02, P < 0.001). Low postoperative fibrinogen levels, and pre-and postoperative use of extracorporeal membrane oxygenation were risk factors for bleeding after lung transplantation.

Extracorporeal membrane oxygenation as a bridge vs. non‐bridging for lung transplantation: A systematic review and meta‐analysis

“…Because of longterm intravascular catheterization and the use of anticoagulants, the risk of thrombosis and bleeding after LT increases greatly in ECMO bridging patients. An astonishing 25.41% (47/185) incidence of postoperative bleeding (requiring reoperation) was found in the BTT group, accompanied by more blood transfusions (mean RBC transfusion: 20.4 u vs. 8.9 u, RR = 12.11) compared with the non-BTT group.Adelmann et al analyzed the risk factors of bleeding complicationsafter LT and reported similar results 34. After ECMO implantation, acquired von Willebrand syndrome (ACWS) can occur in 24 hours and is hard to diagnose with routine coagulation tests 35.…”

Impact Of Surgical Technique And Analgesia On Clinical Outcomes After Lung Transplantation

“…Overall, the duration of mechanical ventilation in our cohort was in line with published data where a 65% of respondents aiming for extubation at 36 hours postoperative 7 , bearing in mind that avoidance of long periods of mechanical ventilation may protect against deleterious effects of recently implanted graft 8 . In a recently published study severe postoperative hemorrhage was associated with use of pre or post-operative ECMO and it was linked to worse 60-day survival after lung transplantation 9 .…”

Initial Postoperative Hemoglobin Values Are Independently Associated With One-Year Mortality in Patients Undergoing Double-Lung Transplantation Requiring Intraoperative Transfusion

“…This cohort was also used in a previous study assessing bleeding complications after lung transplantation. 15 The primary outcome of this study was postoperative mortality during the first year following transplantation. Secondary outcomes were acute kidney injury using 'Kidney Disease Improving Global Outcomes' (KDIGO) criteria during the first week after surgery 17 , time to postoperative extubation, and primary graft failure assessed by a transplant pulmonologist following current guidelines.…”