Allogeneic blood transfusion in bilateral lung transplantation: impact on early function and mortality.
OBJECTIVE
Blood transfusion is associated with higher morbidity and mortality after general cardiothoracic surgery but its impact within the transplant population is unclear. We investigated the profile of blood product transfusion in the bilateral lung transplant population and its impact on function and mortality.


METHODS
Three hundred and eleven adult patients who underwent bilateral lung transplant between 2003 and 2013 were retrospectively reviewed. Patients were stratified according to pretransplant diagnoses and amount of blood products transfused within 24 h of transplant. All-cause mortality at the 1-year follow-up was analysed using a Cox proportional hazards regression model.


RESULTS
One hundred and seventy-four male patients and 137 female patients (mean age = 41.4 ± 14.0 years) underwent bilateral lung transplant using cardiopulmonary bypass for cystic fibrosis (48.9%), fibrotic lung disease (12.2%), emphysema (27.0%), bronchiectasis (5.8%), pulmonary hypertension (1.3%) and others (4.5%). The median number of red blood cells in the first 24 h was 3 (0-40) units, fresh frozen plasma (FFP) = 2 (0-26) units and platelets = 1 (0-7) units. The unadjusted all-cause mortality at the 1-year follow-up did not appear to be different between patient subgroups stratified by the median number of units of red blood cells (P = 0.827) or FFP transfused (P = 0.456). However, 1-year mortality was adversely affected when more than the median number of units of platelets was transfused (P = 0.010). Upon adjustment for confounding variables, 1-year mortality was noted to be greater among patients transfused more than the median unit of platelets (adjusted hazard ratios: 2.3, 95% confidence interval: 1.15-4.61, P = 0.019) and those with longer bypass times (P = 0.046). No significant difference in the number of units transfused was noted when patients were stratified by pretransplant diagnosis. Predicted lung function at 3 and 6 months was not significantly affected by greater blood product use.


CONCLUSIONS
Unlike general cardiothoracic surgery, blood transfusion had no effect on all-cause mortality, whereas a greater administration of platelets was observed to be associated with higher adjusted 1-year mortality. Transfusion rates were not significantly influenced by pretransplant diagnoses. Interestingly, lung function at 3 and 6 months was similar for patients who received more blood product transfusion.
Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK laypingo@gmail.com.
Lay Ping
LP
Ong
Intensive Care Unit, Freeman Hospital, Newcastle Upon Tyne, UK.
Emily
E
Thompson
Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK.
Ashwin
A
Sachdeva
Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.
B C
BC
Ramesh
Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.
Hazel
H
Muse
Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.
Kirstie
K
Wallace
Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.
Gareth
G
Parry
Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.
Stephen Charles
SC
Clark
D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008171:Lung Diseases / Q000401:mortality / Q000601:surgery*; D016040:Lung Transplantation / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D065227:Transfusion Reaction; D016896:Treatment Outcome; D055815:Young Adult
Blood products; Lung transplantation; Mortality; Transfusion