Perioperative Characteristics Associated with Transfusion-Free Lung Transplantation

Abstract

Blood transfusion during lung transplantation (LT) surgery is common. There is little evidence to identify potential candidates for transfusion-free LT surgery. We describe patient and procedural characteristics of LT patients in the era of ECMO and identify predictors of a successful transfusion-free surgery. In this single-center, retrospective analysis, all adult patients undergoing LT between 9/5/2016-2/28/2019 were included. Patients were grouped based on perioperative transfusions received over 72 hours; no products, 1-4 units PRBC, or >4 U PRBC. Donor and recipient characteristics were compared between the three groups by univariate and multivariate analysis. 241 LTs were performed over the time period; 235 were included and 6 multiorgan transplants were excluded. 41 patients (17.4%) received no blood transfusions, while 82.6% (N=194) received transfusions. Most patients (43%, N=101) received >4 U of product. Recipients requiring blood transfusions had associated prolonged ventilation, length of stay, PGD and worsened 1-year graft survival compared to those who did not. Donor characteristics were similar between groups (Fig 1). Older males with obstructive or restrictive lung disease undergoing an off-pump, single lung LT, with lower Lung Allocation Score (LAS), higher starting hemoglobin, shorter ischemic time and case length were associated with a transfusion free LT (Fig 1). In a multivariate analysis, positive predictors for transfusion-free LT included single LT (OR=6.27, p=0.0004), and higher preoperative hemoglobin (OR=1.35 per point, p.0231). Negative predictors included female sex (F v M, OR=0.13, p=0.0005) and higher LAS (OR=0.88 per point, p=0.0002). Predictors of transfusion free LT surgery include older males undergoing a single, off-pump LT procedure, with lower LAS scores and higher starting hemoglobin. This may guide decision making in exploring candidacy for transfusion-free LT or blood refusal patients in the era of ECMO.