Perioperative Characteristics Associated with Transfusion-Free Lung Transplantation

PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Duke Scholars

Author Angela Pollak Anesthesiology, Cardiothoracic

Author Jacob A Klapper Surgery, Cardiovascular and Thoracic Surgery

Author Jessica Lynne Poisson Pathology

Author Lorenzo Zaffiri Medicine, Pulmonary, Allergy, and Critical Care Medicine

Author Matthew Hartwig Surgery, Cardiovascular and Thoracic Surgery

Author Nicole Renee Guinn Anesthesiology, Neuroanesthesia

Author Brandi Anne Bottiger Anesthesiology, Cardiothoracic