• Vladimir Cernak, Annemieke Oude Lansink-Hartgring, Edwin R van den Heuvel, Verschuuren Erik A M EAM Department of Pulmonary Diseases and Lung Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlan, Wim van der Bij, Scheeren Thomas W L TWL Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Gerwin E Engels, Arian F de Geus, Michiel E Erasmus, and Adrianus J de Vries.
• Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: v.cernak@umcg.nl.
• J. Cardiothorac. Vasc. Anesth. 2019 Sep 1; 33 (9): 2478-2486.

ObjectiveTo establish the incidence of massive transfusion and overall transfusion requirements during lung transplantation, changes over time, and association with outcome in relation to patient complexity.DesignRetrospective cohort study.SettingUniversity hospital.ParticipantsAll 514 adult patients who underwent transplantation from 1990 until 2015.InterventionsNone.Measurements And Main ResultsPatient records and transfusion data, divided into 5-year intervals, were analyzed. The incidence of massive transfusion (>10 units of red blood cells [RBCs] in 24 h) was 27% and did not change over time, whereas the median (interquartile range) transfusion requirement in the whole cohort decreased from 8 (5-12) to 3 (0-10) RBCs (p < 0.001). In patients transplanted from the intensive care unit, the incidence of massive transfusion increased over time from 25% to 54% (p = 0.04) and median transfusion requirements from 4.5 (3-8.5) units to 14.5 (5-26) units of RBCs (p = 0.03). Multivariable analysis showed that circulatory support, pulmonary hypertension, re-transplantation, cystic fibrosis, Eisenmenger syndrome, bilateral transplantation, and low body mass index were associated with massive transfusion. Patients with massive transfusion had more primary graft dysfunction grade III at 0, 24, 48, and 72 hours (p < 0.001), higher 30-day mortality (13% v 4%; p < 0.001), and lower 5-year survival (hazard ratio 3.67 [95% confidence interval 1.72-7.85]; p < 0.001).ConclusionThe incidence of massive transfusion did not change over time, whereas transfusion requirements in the whole cohort decreased. In patients transplanted from the intensive care unit, massive transfusion and transfusion requirements increased. Massive transfusion was associated with poor outcome.Copyright © 2019 Elsevier Inc. All rights reserved.

19 keywords...

hide…