Separate Effect of Perioperative Recombinant Human Factor VIIa Administration and Packed Red Blood Cell Transfusions on Midterm Survival in Lung Transplantation Recipients
| Autor: | Kathleen Kane, Stephen Qi, Sara J. Shumway, Tjorvi E. Perry, Rosemary F. Kelly, Nicholas T. Lemke, Andrew Shaffer, Scott A. Jackson, Matthew Soule, Marshall I. Hertz, Stephen J. Huddleston |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Blood transfusion medicine.medical_treatment Factor VIIa 030204 cardiovascular system & hematology Gastroenterology Packed Red Blood Cell Transfusion 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Blood product Internal medicine medicine Lung transplantation Humans Proportional Hazards Models Retrospective Studies business.industry Hazard ratio Red blood cell Anesthesiology and Pain Medicine medicine.anatomical_structure Cardiology and Cardiovascular Medicine business Packed red blood cells Erythrocyte Transfusion Lung allocation score Lung Transplantation |
| Zdroj: | Journal of cardiothoracic and vascular anesthesia. 34(11) |
| ISSN: | 1532-8422 |
| Popis: | Objective The purpose of this study was to determine the relationship between blood product transfusion, with or without recombinant human activated factor VIIa, and survival after lung transplantation. Design Retrospective analysis of a single center with follow-up out to 6 years post-transplantation. Setting Single-center academic lung transplantation program. Participants The study comprised 265 adult patients who underwent single or bilateral sequential lung transplantation from March 2011 to June 2017. Interventions Overall survival using Kaplan-Meier curves was compared among the following 3 cohorts: those not transfused with blood products, those transfused with blood products, and those given blood products and recombinant human activated factor VIIa. Cox proportional hazards regression was used to estimate hazard ratios (HRs), confidence intervals (CIs), and p values. Measurements and Main Results Seventy-eight patients received no packed red blood cell transfusions, 149 received packed red blood cell transfusions, and 38 received both packed red blood cell transfusions and recombinant human activated factor VII. Packed red blood cell transfusion was associated with an increased risk of mortality that did not reach statistical significance (HR 2.168, CI 0.978-4.805; p = 0.057). Additional packed red blood cells beyond 15 U were associated with worsened survival (HR 1.363, CI 1.137-1.633; p = 0.001), but recombinant human activated factor VIIa did not increase the risk of mortality. Conclusion Blood product transfusion during and after lung transplantation is associated with decreased survival, especially with large-volume transfusions. Survival is not worse with recombinant human activated factor VIIa administration, but additional studies are needed to determine whether recombinant human activated factor VIIa administration reduces the need for blood product transfusions. |
| Databáze: | OpenAIRE |
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