Incidence and Potentially Modifiable Risk Factors for Venous Thromboemblism Post Lung Transplant

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Venous thromboembolism (VTE) is a frequent complication after lung transplantation. Most VTE occur within 30 days of surgery and consist primarily of upper extremity deep venous thrombosis (DVT). Prior studies have described incidence rates of up to 43%, which is much higher than in other solid organ transplantation. VTE after lung transplantation has been associated with a lower survival post-transplant. Due to the morbidity and costs incurred by this complication, modifiable post-operative risk factors must be identified to improve our outcomes after lung transplantation. Retrospective study population of patients who received a lung transplant at Temple University Hospital, Philadelphia, between 2017 and 2018 (n=197). We collected baseline demographics, laboratory values, intra-operative variables, as well as post-operative care measures such as central line days, pulmonary artery catheter days, days to physical therapy, initiation timing and interruptions in pharmacologic prophylaxis. The primary outcome was VTE event within one year of lung transplantation. 197 lung transplants were performed (R: 73 L: 70, double: 54) with a mean age of 65.5 years, most common indications were IPF (53%) and COPD (32.5%). The incidence of VTE within one year of transplant was 23.5% (n=47), most of which occurred within 30 days of transplant (72%). Most patients had upper extremity DVT (55%) and was treated with systemic anticoagulation (83%). Patients who had VTE after transplant tended to have a higher BMI (p=0.0048) and oxygen requirement (p=0.028) pre-operatively. Patients with VTE had a longer duration of Swan-Ganz catheter (p=0.0145) and the introducer catheter (p=0.0092). VTE patients had a longer time to physical therapy (p=0.06) and time to ambulation (p=0.0471) post-surgery. On multivariate analysis, interruptions in pharmacologic VTE prophylaxis within the first five days post-operatively was the only modifiable risk factor identified (OR, 4.123, % CI, 1.642-10.352, p=<0.0001). Unlike previous studies, we did not find an association between VTE post-transplant and a history of prior VTE, LAS score, diabetes, or age. Any interruption in DVT prophylaxis early post-transplant is a significant "modifiable" risk factor for development of VTE. Every effort should thus be made to avoid any interruption in prophylaxis.