title: Effects of Perioperative Fluid Replacement Therapy in Lung Transplant Patients.
abstract: OBJECTIVE
  Approximately 10 to 25 lung transplant procedures are performed annually in Finland, and 1-year survival has been 95% over the last 10 years. Our aim was to find associations between perioperative fluid replacement therapies and postoperative patient outcomes, with special emphasis on the use of colloids and blood products.
  
  
  METHODS
  We retrospectively evaluated data from 100 patients who underwent lung transplant with cardiopulmonary bypass support in Finland from 2007 to 2013. Outcomes of interest were length of intensive care unit and hospital stays, time in ventilator, use of extracorporeal membrane oxygenation postoperatively, postoperative renal replacement therapy, postoperative graft failure, and 1-year mortality.
  
  
  RESULTS
  Of 100 patients, 12 were on extracorporeal membrane oxygenation preoperatively. The 1-year mortality was 5/100 (5%), and the 3-year mortality was 7/100 (7%). Intraoperative fluid balance was positive (4762 a 3018 mL) but fell significantly postoperatively (below +1000 mL on postoperative day 1). During postoperative days 2 to 7, net fluid balance continued decreasing and stayed negative. Intraoperative use of hydroxyethyl starch and fresh frozen plasma were significantly higher in patients who died during follow-up versus those who survived (P < .05). Intraoperative use of fresh frozen plasma, but not red blood cells or platelets, correlated with graft failure (P = .012). Postoperative use of colloids or blood products did not correlate with mortality or graft failure. Patients who were on extracorporeal membrane oxygenation preoperatively stayed longer on ventilators and had longer intensive care unit and hospital stays (P < .001). Eight patients needed postoperative renal replacement therapy.
  
  
  CONCLUSIONS
  Intraoperative use of fresh frozen plasma and hydroxyethyl starch is associated with increased mortality and graft failure. Postoperative use of colloids and red blood cells did not correlate with patient outcome. Use of extracorporeal membrane oxygenation preoperatively resulted in prolonged length of hospital stay.
authors.affiliation: rom the University of Helsinki, Helsinki, Finland.
authors.forename: Emil
authors.initials: E
authors.lastname: Björkbom
authors.forename: Pekka
authors.initials: P
authors.lastname: Hämmäinen
authors.forename: Alexey
authors.initials: A
authors.lastname: Schramko
mesh_terms: D000328:Adult; D016913:Blood Component Transfusion / Q000009:adverse effects* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D003102:Colloids; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005387:Finland; D005440:Fluid Therapy / Q000009:adverse effects* / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects*; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D010952:Plasma Substitutes / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D017582:Renal Replacement Therapy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003102:Colloids; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes