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Effects of a Goal Directed Transfusion Protocol on Severe Primary Graft Dysfunction after Lung Transplantation

Publication ,  Conference
Pollak, AL; Poisson, J; Cooter, M; Barac, YD; Bryner, B; Haney, J; Hartwig, MG; Klapper, J; Zaffiri, L; Welsby, I; Hashmi, N; Bottiger, B
Published in: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
April 1, 2020

PURPOSE: Transfusion during lung transplantation (LT) is linked to primary graft dysfunction (PGD) and worsened outcomes. Goal-directed protocols have improved outcomes in cardiac surgical populations and decreased transfusions in LT on cardiopulmonary bypass. We propose that the implementation of goal-directed transfusion protocol for LT would reduce the rate of transfusion and PGD grade 3 at 72hrs. METHODS: We included adult LT patients performed on and off mechanical circulatory support (MCS) between March 1, 2017 and February 28, 2019. Patients undergoing multi-organ transplant, preoperative MCS, or who received preoperative transfusions were excluded. A ROTEM-guided transfusion algorithm was implemented February 28, 2018. Demographic and procedural characteristics of patients were compared pre- and post-protocol. The primary outcome was PGD grade 3 at 72hrs, as defined by 2016 ISHLT criteria. PGD was trended by month before and after implementation. Adherence was defined as the presence of intraoperative ROTEM results. RESULTS: 188 patients were included, and grouped by time period either into pre-protocol (N=101) or post-protocol (N=87). There were no statistically significant  differences in procedural or demographic characteristics between groups (Table 1). While the PGD rate decreased from 27.7% (n=28) in the pre-period to 20.7% (n=18) in the post-period, this was a not statistically significant (p=0.26). Intraoperative protocol labs were sent in in 77% (n=67) of the post-protocol patients. PGD during the post-period was 25% in the non-adherent protocol cases and 19% in the protocol adherent cases (p=0.54). CONCLUSION: While we previously described a consistent reduction of median RBC units transfused post-protocol over 12 months, this protocol did not result in a consistently reduced severe PGD rate. Over 12 months, we observed a trend in reduced PGD rates after implementing our transfusion protocol. Teams should consider goal-directed transfusion protocols for LT.

Duke Scholars

Published In

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

DOI

EISSN

1557-3117

Publication Date

April 1, 2020

Volume

39

Issue

4

Start / End Page

S330

Related Subject Headings

  • Surgery
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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Pollak, A. L., Poisson, J., Cooter, M., Barac, Y. D., Bryner, B., Haney, J., … Bottiger, B. (2020). Effects of a Goal Directed Transfusion Protocol on Severe Primary Graft Dysfunction after Lung Transplantation. In The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (Vol. 39, p. S330). https://doi.org/10.1016/j.healun.2020.01.349
Pollak, A. L., J. Poisson, M. Cooter, Y. D. Barac, B. Bryner, J. Haney, M. G. Hartwig, et al. “Effects of a Goal Directed Transfusion Protocol on Severe Primary Graft Dysfunction after Lung Transplantation.” In The Journal of Heart and Lung Transplantation : The Official Publication of the International Society for Heart Transplantation, 39:S330, 2020. https://doi.org/10.1016/j.healun.2020.01.349.
Pollak AL, Poisson J, Cooter M, Barac YD, Bryner B, Haney J, et al. Effects of a Goal Directed Transfusion Protocol on Severe Primary Graft Dysfunction after Lung Transplantation. In: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2020. p. S330.
Pollak, A. L., et al. “Effects of a Goal Directed Transfusion Protocol on Severe Primary Graft Dysfunction after Lung Transplantation.” The Journal of Heart and Lung Transplantation : The Official Publication of the International Society for Heart Transplantation, vol. 39, no. 4, 2020, p. S330. Scopus, doi:10.1016/j.healun.2020.01.349.
Pollak AL, Poisson J, Cooter M, Barac YD, Bryner B, Haney J, Hartwig MG, Klapper J, Zaffiri L, Welsby I, Hashmi N, Bottiger B. Effects of a Goal Directed Transfusion Protocol on Severe Primary Graft Dysfunction after Lung Transplantation. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2020. p. S330.
Journal cover image

Published In

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

DOI

EISSN

1557-3117

Publication Date

April 1, 2020

Volume

39

Issue

4

Start / End Page

S330

Related Subject Headings

  • Surgery
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology