Effects of a Goal Directed Transfusion Protocol on Severe Primary Graft Dysfunction after Lung Transplantation
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
DOI
EISSN
Publication Date
Volume
Issue
Start / End Page
Related Subject Headings
- Surgery
- 3202 Clinical sciences
- 3201 Cardiovascular medicine and haematology
- 1102 Cardiorespiratory Medicine and Haematology
Citation
Published In
DOI
EISSN
Publication Date
Volume
Issue
Start / End Page
Related Subject Headings
- Surgery
- 3202 Clinical sciences
- 3201 Cardiovascular medicine and haematology
- 1102 Cardiorespiratory Medicine and Haematology