title: Impact of preoperative right-ventricular function and platelet transfusion on outcome after lung transplantation.
abstract: OBJECTIVE
  Lung transplantation has become an established treatment option for end-stage pulmonary diseases. However, outcome depends on preoperative condition and co-morbidity. Furthermore, perioperative blood-product use is known to be associated with worse outcome even in transplant surgery. We investigated the impact of poor preoperative right-ventricular function and blood-product use on outcome after lung transplantation.
  
  
  METHODS
  The medical records of 169 lung-transplant recipients from 1996 to 2006 were examined. Duration of hospital stay, hours on mechanical ventilation, duration of stay in the intensive care unit, perioperative complications, death during hospital stay, and long-term survival were recorded. These outcome parameters were analyzed regarding coherence with right-ventricular function and the perioperative administration of crystalloids, colloids, allogeneic red blood cells, fresh frozen plasma, and platelets.
  
  
  RESULTS
  Patients with poor preoperative right-ventricular function had a significant increase in postoperative hours on ventilation (p=0.005), intensive care stay (p=0.003), and in-hospital death (p=0.012). The hours on ventilation increased also with high intra-operative fluid administration (p=0.026). Blood-product use was associated with prolonged mechanical ventilation and intensive care stay. After multivariate analysis, transfusion of platelets (p=0.022) was an independent prognostic factor for in-hospital death. Hours of mechanical ventilation was the only independent prognostic factor for long-term mortality (p=0.014).
  
  
  CONCLUSIONS
  Perioperative transfusion of platelets is an independent prognostic factor for perioperative mortality. Furthermore, the study indicated that poor preoperative right-ventricular function might worsen perioperatively after lung transplantation. Therefore, pre-transplant treatment of pulmonary hypertension to protract right-ventricular failure and a restrictive use of allogeneic blood products may be options to improve outcome.
authors.affiliation: Institute of Anaesthesiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland. marco.zalunardo@usz.ch
authors.forename: Marco P
authors.initials: MP
authors.lastname: Zalunardo
authors.forename: Caroline
authors.initials: C
authors.lastname: Thalmann
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Jaya
authors.initials: J
authors.lastname: D'Cunja
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
authors.forename: Annette
authors.initials: A
authors.lastname: Boehler
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
mesh_terms: D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000401:mortality / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D057234:Preoperative Period; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000401:mortality