Intra-Operative Transfusions are Associated with Worse Outcomes after Lung Transplantation

Abstract

Purpose Peri-operative blood transfusions are associated with increased pulmonary morbidity and mortality. The impact of blood transfusions during lung transplantation surgery is largely unknown. We investigated the impact of intra-operative blood transfusions on acute rejection, post-transplant lung function and mortality in lung transplant recipients. Methods A retrospective review was conducted on 274 adult patients who underwent bilateral lung transplantation from January 2012 to June 2018. Intra-operative transfusions of red blood cells (RBC), fresh frozen plasma (FFP), platelets and cryoprecipitate were analysed. Logistic regression was used to determine variables predicting higher blood product use. Kaplan-Meier and Cox proportional hazard models were used to analyse time-to-first rejection/death and all-cause mortality. Results 149 men and 125 women (median age 55, range 18 to 69) required a median number of 2 units of red blood cells (range, 0 to 22 units), 2 units of fresh frozen plasma (range, 0 to 10 units), 1 unit of platelets (range, 0 to 4 units) and 2 units of cryoprecipitate (range, 0 to 16 units). Female patients (p 0.001), longer CPB time (p 0.024) and lower pre-operative haemoglobin (p 0.001) predicted greater RBC use. Greater transfusions of all blood products were significantly associated with prolonged hospital stays, ICU stays and ventilation time. Mortality risk was not significantly different for any transfusion product. Time-to-first A3 or higher rejection and the number of rejections in the first year post-transplant were not significantly related to increased blood product use. However, increased cryoprecipitate transfusion was associated with greater severity of rejections. Post-transplant predicted forced expiratory volume in 1 second at 3 months, 6 months and 12 months was significantly worse if patients received more intra-operative blood products. Conclusion Increased intra-operative blood transfusions in lung transplant recipients did not significantly increase risk of lung rejection or mortality. However, increased blood transfusions were associated with prolonged hospital stay, ICU stay and ventilation time. Higher volumes of all blood products were also show significantly worse lung function up to 1 year post-transplant.