Allogeneic blood transfusion in bilateral lung transplantation: impact on early function and mortality
| Autor: | Kirstie Wallace, B.C. Ramesh, Emily R Thompson, Hazel Muse, Gareth Parry, Stephen Clark, Ashwin Sachdeva, Lay Ping Ong |
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| Rok vydání: | 2014 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Lung Diseases Male medicine.medical_specialty Blood transfusion Adolescent medicine.medical_treatment Population 030204 cardiovascular system & hematology Perioperative Care Pulmonary function testing 03 medical and health sciences Young Adult 0302 clinical medicine Postoperative Complications Blood product Internal medicine medicine Lung transplantation Humans Blood Transfusion education Lung Aged Proportional Hazards Models Retrospective Studies education.field_of_study business.industry Hazard ratio Transfusion Reaction General Medicine Middle Aged Surgery Transplantation Treatment Outcome 030228 respiratory system Female Fresh frozen plasma Cardiology and Cardiovascular Medicine business Follow-Up Studies Lung Transplantation |
| Zdroj: | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 49(2) |
| ISSN: | 1873-734X |
| Popis: | Objectives: 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. |
| Databáze: | OpenAIRE |
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