1. The Association of Increased FFP:RBC Transfusion Ratio to Primary Graft Dysfunction in Bleeding Lung Transplantation Patients
- Author
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Nicole R. Guinn, Matthew G. Hartwig, Ben Bryner, Theresa Seay, Angela Pollak, Jacob A. Klapper, Yasmin Maisonave, John C. Haney, Jessica Poisson, Matt Fuller, and Brandi A. Bottiger
- Subjects
Adult ,medicine.medical_specialty ,Erythrocytes ,medicine.medical_treatment ,Primary Graft Dysfunction ,030204 cardiovascular system & hematology ,Plasma ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Blood product ,Internal medicine ,Humans ,Medicine ,Lung transplantation ,Blood Transfusion ,Platelet ,Retrospective Studies ,Rbc transfusion ,Lung ,business.industry ,respiratory system ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Cohort ,Fresh frozen plasma ,Erythrocyte Transfusion ,Cardiology and Cardiovascular Medicine ,business ,Lung Transplantation - Abstract
Lung transplantation is associated with a significant risk of needed transfusion. Although algorithm-based transfusion strategies that promote a high fresh frozen plasma:red blood cells (FFP:RBC) ratio have reduced overall blood product requirements in other populations, large-volume transfusions have been linked to primary graft dysfunction (PGD) in lung transplantation, particularly use of platelets and plasma. The authors hypothesized that in lung transplant recipients requiring large-volume transfusions, a higher FFP:RBC ratio would be associated with increased PGD severity at 72 hours.Observational retrospective review.Single tertiary academic center.Adult patients undergoing bilateral or single orthotopic lung transplantation and receiving4 U PRBC in the first 72 hours from February 2014 to March 2019.None.Patient demographics, operative characteristics, blood transfusions, and outcomes including PGD scores and length of stay were collected. Eighty-nine patients received4U PRBC, had available 72-hour PGD data, and were included in the study. These patients were grouped into a high-ratio (1:2 units of FFP:RBC, N = 38) or low-ratio group (1:2 units of FFP:RBC, N = 51). Patients in the high-ratio group received more transfusions and factor concentrates and had significantly longer case length. The high-ratio group had a higher rate of severe PGD at 72 hours (60.5% v 23.5%, p = 0.0013) and longer hospital length of stay (40 v 32 days, p = 0.0273).In bleeding lung transplantation patients at high risk for PGD, a high FFP:RBC transfusion ratio was associated with worsened 72-hour PGD scores when compared with the low-ratio cohort.
- Published
- 2020