Kaihou Taisuke, Toyoda Takahide, Cerier Emily, Yagi Yuriko, Manerikar Adwaiy, Thomae Benjamin Louis, Kandula Viswajit, Bharat Ankit, Kurihara Chitaru
Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Ann Thorac Surg Short Rep. 2024 Mar 5;2(3):573-577. doi: 10.1016/j.atssr.2024.02.004. eCollection 2024 Sep.
Primary graft dysfunction (PGD) is the leading cause of short- and long-term mortality associated with lung transplantation. The impact of pretransplantation blood transfusions for recipients is not fully elucidated.
This is a retrospective review of 206 consecutive lung transplantations performed at a single academic center (Northwestern University Feinberg School of Medicine, Chicago, IL) from January 2018 to July 2022. Data on patient characteristics, pretransplantation laboratory values, transfusion requirements, and intraoperative and postoperative outcomes were collected.
PGD grade 3 (PGD 3) occurred in 13.2% of the cohort (n = 28). A total of 33 patients received a blood transfusion within 4 weeks, whereas 21 patients received a blood transfusion a week before their lung transplant. Pretransplantation transfusions were strongly associated with a higher incidence of PGD 3 (48.5% vs 6.9%; < .001). There was no significant difference in 1-year survival between the pretransplantation transfused group and the nontransfused group (77.7% vs 88.0%; = .478). The 1year survival was reduced in recipients with PGD 3 compared with recipients without PGD 3 (63.5% vs 89.9%; = .0012). In univariate analysis, pretransplant and intratransplant predictors of PGD 3 included younger age ( < .01), pretransplant extracorporeal membrane oxygenation (ECMO) use ( < .001), higher lung allocation score ( < .001), coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome ( < .01), blood transfusion within 4 weeks ( < .001), longer operative time ( < .001), intratransplant blood transfusion ( < .001), and intratransplant venoarterial ECMO use ( < .001).
Pretransplantation blood transfusions could be associated with a higher rate of PGD. The findings indicated the potential risks of pretransplantation blood transfusions in lung transplant recipients.
原发性移植肺功能障碍（PGD）是与肺移植相关的短期和长期死亡率的主要原因。移植前输血对受者的影响尚未完全阐明。
这是一项对2018年1月至2022年7月在单一学术中心（伊利诺伊州芝加哥市西北大学费恩伯格医学院）连续进行的206例肺移植手术的回顾性研究。收集了患者特征、移植前实验室检查值、输血需求以及术中和术后结果的数据。
该队列中13.2%（n = 28）的患者发生了3级PGD（PGD 3）。共有33例患者在4周内接受了输血，而21例患者在肺移植前一周接受了输血。移植前输血与PGD 3的较高发生率密切相关（48.5%对6.9%；P <.001）。移植前输血组和未输血组的1年生存率无显著差异（77.7%对88.0%；P = 0.478）。与无PGD 3的受者相比，发生PGD 3的受者1年生存率降低（63.5%对89.9%；P = 0.0012）。在单因素分析中，PGD 3的移植前和移植中预测因素包括年龄较小（P < 0.01）、移植前使用体外膜肺氧合（ECMO）（P < 0.001）、较高的肺分配评分（P < 0.001）、2019冠状病毒病（COVID-19）相关急性呼吸窘迫综合征（P < 0.01）、4周内输血（P < 0.001）、手术时间较长（P < 0.001）、移植中输血（P < 0.001）以及移植中使用静脉-动脉ECMO（P < 0.001）。
移植前输血可能与较高的PGD发生率相关。这些发现表明了肺移植受者移植前输血的潜在风险。
