title: Massive donor transfusion potentially increases recipient mortality after lung transplantation.
abstract: Donor blood transfusion has been identified as a potential risk factor for primary graft dysfunction and by extension early mortality. We sought to define the contributing risk of donor transfusion on early mortality for lung transplant.
  
  
  
  Donor and recipient data were abstracted from the Organ Procurement and Transplantation Network database updated through June 30, 2014, which included 86,398 potential donors and 16,255 transplants. Using the United Network for Organ Sharing 4-level designation of transfusion (no blood, 1-5 units, 6-10 units, and >10 units, massive), we analyzed all-cause mortality at 30-days with the use of logistic regression adjusted for confounders (ischemic time, donor age, recipient diagnosis, lung allocation score and recipient age, and recipient body mass index). Secondary analyses assessed 90-day and 1-year mortality and hospital length of stay.
  
  
  
  Of the 16,255 recipients transplanted, 8835 (54.35%) donors received at least one transfusion. Among those transfused, 1016 (6.25%) received a massive transfusion, defined as >10 units. Those donors with massive transfusion were most commonly young trauma patients. After adjustment for confounding variables, donor massive transfusion was associated significantly with an increased risk in 30-day (P = .03) and 90-day recipient mortality (P = .01) but not 1-year mortality (P = .09). There was no significant difference in recipient length of stay or hospital-free days with respect to donor transfusion.
  
  
  
  Massive donor blood transfusion (>10 units) was associated with early recipient mortality after lung transplantation. Conversely, submassive donor transfusion was not associated with increased recipient mortality. The mechanism of increased early mortality in recipients of lungs from massively transfused donors is unclear and needs further study but is consistent with excess mortality seen with primary graft dysfunction in the first 90 days posttransplant.
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Catherine F
authors.initials: CF
authors.lastname: Borders
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Jared
authors.initials: J
authors.lastname: Lasky
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Christian
authors.initials: C
authors.lastname: Schaufler
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Djamila
authors.initials: D
authors.lastname: Mallem
authors.affiliation: Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: James
authors.initials: J
authors.lastname: Lee
authors.affiliation: Transplant Institute, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Kevin
authors.initials: K
authors.lastname: Carney
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Scarlett L
authors.initials: SL
authors.lastname: Bellamy
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bermudez
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
authors.affiliation: Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, Pa; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Christie
authors.affiliation: Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Diamond
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa. Electronic address: edward.cantu@uphs.upenn.edu.
authors.forename: Edward
authors.initials: E
authors.lastname: Cantu
mesh_terms: D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion / Q000401:mortality*; D002423:Cause of Death; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: blood transfusion; lung transplantation