Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
Division of Cardiothoracic Transplantation and Mechanical Circulatory Support, Baylor College of Medicine, Houston, TX.
Transplantation. 2023 Jul 1;107(7):1573-1579. doi: 10.1097/TP.0000000000004545. Epub 2023 Mar 24.
In this international, multicenter study of patients undergoing lung transplantation (LT), we explored the association between the amount of intraoperative packed red blood cell (PRBC) transfusion and occurrence of primary graft dysfunction (PGD) and associated outcomes.
The Extracorporeal Life Support in LT Registry includes data on LT recipients from 9 high-volume (>40 transplants/y) transplant centers (2 from Europe, 7 from the United States). Adult patients who underwent bilateral orthotopic lung transplant from January 2016 to January 2020 were included. The primary outcome of interest was the occurrence of grade 3 PGD in the first 72 h after LT.
We included 729 patients who underwent bilateral orthotopic lung transplant between January 2016 and November 2020. LT recipient population tertiles based on the amount of intraoperative PRBC transfusion (0, 1-4, and >4 units) were significantly different in terms of diagnosis, age, gender, body mass index, mean pulmonary artery pressure, lung allocation score, hemoglobin, prior chest surgery, preoperative hospitalization, and extracorporeal membrane oxygenation requirement. Inverse probability treatment weighting logistic regression showed that intraoperative PRBC transfusion of >4 units was significantly ( P < 0.001) associated with grade 3 PGD within 72 h (odds ratio [95% confidence interval], 2.2 [1.6-3.1]). Inverse probability treatment weighting analysis excluding patients with extracorporeal membrane oxygenation support produced similar findings (odds ratio [95% confidence interval], 2.4 [1.7-3.4], P < 0.001).
In this multicenter, international registry study of LT patients, intraoperative transfusion of >4 units of PRBCs was associated with an increased risk of grade 3 PGD within 72 h. Efforts to improve post-LT outcomes should include perioperative blood conservation measures.
在这项针对接受肺移植（LT）的患者的国际多中心研究中，我们探讨了术中输注的浓缩红细胞（PRBC）量与原发性移植物功能障碍（PGD）的发生及其相关结局之间的关联。
体外生命支持在 LT 登记处包含了来自 9 个大容量（>40 例/年）移植中心（2 个来自欧洲，7 个来自美国）的 LT 受者的数据。纳入了 2016 年 1 月至 2020 年 1 月期间接受双侧原位肺移植的成年患者。主要观察终点为 LT 后 72 小时内发生的 3 级 PGD。
我们纳入了 2016 年 1 月至 2020 年 11 月期间接受双侧原位肺移植的 729 例患者。根据术中 PRBC 输注量（0、1-4 和>4 单位）将 LT 受者人群分为三个三分位，在诊断、年龄、性别、体重指数、平均肺动脉压、肺分配评分、血红蛋白、既往胸部手术、术前住院时间和体外膜氧合需求方面存在显著差异。逆概率治疗权重逻辑回归显示，术中输注>4 单位的 PRBC 与 72 小时内 3 级 PGD 显著相关（比值比[95%置信区间]，2.2[1.6-3.1]）。排除体外膜氧合支持患者的逆概率治疗权重分析得出了类似的发现（比值比[95%置信区间]，2.4[1.7-3.4]，P<0.001）。
在这项针对 LT 患者的多中心国际登记研究中，术中输注>4 单位的 PRBC 与 72 小时内 3 级 PGD 的风险增加相关。改善 LT 后结局的努力应包括围手术期血液保护措施。
