Transfusion-related acute lung injury (TRALI) in graft by blood donor antibodies against host leukocytes

Goodwin, Jodi; Tinckam, Kathryn; denHollander, Neal; Haroon, Ayesha; Keshavjee, Shaf; Cserti‐Gazdewich, Christine

doi:10.1016/j.healun.2010.04.019

Cited by 7 publications

(5 citation statements)

References 22 publications

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“…Transfusion of a large amount of blood products, especially FFP, to manage intraoperative blood loss during LuTx is an independent risk factor for PGD through transfusion-related acute lung injury (TRALI) [27][28][29]. Diamond et al reported that the prevalence of greater than 1 L RBC intraoperative transfusion was 34%, and in the adjusted analysis, this was associated with a nearly twofold increased risk for the development of PGD grade 3 [30].…”

Section: Discussionmentioning

confidence: 99%

Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial

et al. 2023

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Background Primary graft dysfunction (PGD) after lung transplantation (LuTx) contributes substantially to early postoperative morbidity. Both intraoperative transfusion of a large amount of blood products during the surgery and ischemia–reperfusion injury after allograft implantation play an important role in subsequent PGD development. Methods We have previously reported a randomized clinical trial of 67 patients where point of care (POC) targeted coagulopathy management and intraoperative administration of 5% albumin led to significant reduction of blood loss and blood product consumption during the lung transplantation surgery. A secondary analysis of the randomized clinical trial evaluating the effect of targeted coagulopathy management and intraoperative administration of 5% albumin on early lung allograft function after LuTx and 1-year survival was performed. Results Compared to the patients in the control (non-POC) group, those in study (POC) group showed significantly superior graft function, represented by the Horowitz index (at 72 h after transplantation 402.87 vs 308.03 with p < 0.001, difference between means: 94.84, 95% CI: 60.18–129.51). Furthermore, the maximum doses of norepinephrine administered during first 24 h were significantly lower in the POC group (0.193 vs 0.379 with p < 0.001, difference between the means: 0.186, 95% CI: 0.105–0.267). After dichotomization of PGD (0–1 vs 2–3), significant difference between the non-POC and POC group occurred only at time point 72, when PGD grade 2–3 developed in 25% (n = 9) and 3.2% (n = 1), respectively (p = 0.003). The difference in 1-year survival was not statistically significant (10 patients died in non-POC group vs. 4 patients died in POC group; p = 0.17). Conclusions Utilization of a POC targeted coagulopathy management combined with Albumin 5% as primary resuscitative fluid may improve early lung allograft function, provide better circulatory stability during the early post-operative period, and have potential to decrease the incidence of PGD without negative effect on 1-year survival. Trial registration This clinical trial was registered at ClinicalTrials.gov (NCT03598907).

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Section: Discussionmentioning

confidence: 99%

Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial

et al. 2023

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“…Again, risk factors can be categorized as pre-existing/inherited and acquired. Pre-existing risk factors are similar between donors and recipients and include age, gender, and race [29,30]. Acquired recipient risk factors include elevated body mass index, pulmonary hypertension, idiopathic pulmonary fibrosis, sarcoidosis, underlying liver, and kidney disease, and heart failure, which are all associated with increased risk of PGD postoperatively.…”

Section: Posttransplant/recipient Risk Factors For Pgdmentioning

confidence: 99%

“…Certain risk factors are associated with the transplantation surgery itself including the use of transfusions, elevated pulmonary artery pressures, and excessive mechanical ventilation. Transfusion-related lung injury (TRALI) is a known risk factor for PGD postoperatively resulting from intraoperative blood transfusions [30]. The manner in which reperfusion is carried out also influences PGD development.…”

Section: Posttransplant/recipient Risk Factors For Pgdmentioning

confidence: 99%

Lung Transplantation, Pulmonary Endothelial Inflammation, and Ex-Situ Lung Perfusion: A Review

Forgie

Fialka

Freed

et al. 2021

Cells

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Lung transplantation (LTx) is the gold standard treatment for end-stage lung disease; however, waitlist mortality remains high due to a shortage of suitable donor lungs. Organ quality can be compromised by lung ischemic reperfusion injury (LIRI). LIRI causes pulmonary endothelial inflammation and may lead to primary graft dysfunction (PGD). PGD is a significant cause of morbidity and mortality post-LTx. Research into preservation strategies that decrease the risk of LIRI and PGD is needed, and ex-situ lung perfusion (ESLP) is the foremost technological advancement in this field. This review addresses three major topics in the field of LTx: first, we review the clinical manifestation of LIRI post-LTx; second, we discuss the pathophysiology of LIRI that leads to pulmonary endothelial inflammation and PGD; and third, we present the role of ESLP as a therapeutic vehicle to mitigate this physiologic insult, increase the rates of donor organ utilization, and improve patient outcomes.

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“…Another risk factor associated with surgery is the transfusion of blood components. It is known that intraoperative transfusions cause transfusion-related lung injury (TRALI), which is similar to ARDS and PGD in the post-operative stage and should be considered in the differential diagnosis (25).…”

Section: Surgery-related Risk Factorsmentioning

confidence: 99%

Primary Graft Dysfunction after Lung Transplantation

Altun

Arslantaş

Cinel

2020

Turk J Anaesthesiol Reanim

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Primary graft dysfunction (PGD) is a severe form of acute lung injury that is a major cause of early morbidity and mortality encountered after lung transplantation. PGD is diagnosed by pulmonary oedema with diffuse alveolar damage that manifests clinically as progressive hypoxemia with radiographic pulmonary infiltrates. Inflammatory and immunological response caused by ischaemia and reperfusion is important with regard to pathophysiology. PGD affects short-and long-term outcomes, the donor organ is the leading factor affecting these adverse ramifications. To minimize the risk of PGD, reduction of lung ischaemia time, reperfusion optimisation, prostaglandin level regulation, haemodynamic control, hormone replacement therapy, ventilator management are carried out; for research regarding donor lung preparation strategies, certain procedures are recommended. In this review, recent updates in epidemiology, pathophysiology, molecular and genetic biomarkers and technical developments affecting PGD are described.

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Transfusion-related acute lung injury (TRALI) in graft by blood donor antibodies against host leukocytes

Cited by 7 publications

References 22 publications

Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial

Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial

Lung Transplantation, Pulmonary Endothelial Inflammation, and Ex-Situ Lung Perfusion: A Review

Primary Graft Dysfunction after Lung Transplantation

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