Bloodless Lung Transplantation: a Single Center Experience

Abstract

Background: In cardiothoracic surgery, the potentially detrimental effects of transfusions on patient outcome are increasingly appreciated. In lung transplantation only two transfusion free single lung transplantations have been reported so far. Here we report the first 10 patients undergoing bloodless lung transplantation in our institution. Methods: Since January 2009 10 out of 67 patients underwent lung transplantation without the use of any transfusion of allogeneic blood or blood products. There were nine male and one female patient with a median age of 57 years (range 21-70 years). Nine transplantations were performed as sequential bilateral and one as single right lung transplantation. Primary diagnosis was chronic obstructive pulmonary disease in seven, idiopathic lung fibrosis in two and cystic fibrosis in one patient (Jehovah's Witness). All operations were performed off-pump using the minimally invasive anterolateral thoracotomy technique. Coagulation management was ACT adjusted. Results: The rate of transfusion free lung transplantation in our institution is 15%. Thirty-day survival after bloodless lung transplantation was 100% and 6-month survival was 87.5%. Conclusion: Bloodless single and bilateral lung transplantation is feasible. Based on our experience patients who refuse blood transfusions for religious reasons should not be excluded from lung transplantation. Combination of limited, minimally invasive surgical technique with a carefully adjusted coagulation management and with a blood conservation strategy appear to be important for success.