Factors associated with intraoperative blood transfusion in lung transplantation and their impacts on prognosis

  Background  Blood transfusion is one of the important treatment measures in lung transplantation, and its incidence is affected by many factors. Excessive blood transfusion may affect the prognosis of lung transplantation.

  Objective  To analyze the factors associated with intraoperative blood transfusion during lung transplantation in a single center, and explore the relationship between blood transfusion and prognosis of lung transplantation.

  Methods  This retrospective analysis included 194 consecutive lung transplantations in our hospital from March 2017 to June 2019. The lung transplant recipients were divided into blood transfusion group (n=65) and non-blood transfusion group (n=129) according to the blood transfusion during operation. Clinical data about patients in the two groups, the risk factors of transfusion during operation and their prognosis were analyzed.

  Results  The incidence of blood transfusion was 33.5%. Preoperative anticoagulant therapy, low preoperative hemoglobin, high preoperative international normalized ratio (INR), intrathoracic adhesion and long operation time resulted in increased blood transfusion (P＜0.05). The overall survival rate of transfusion recipients was significantly lower than that of the non-transfusion recipients (P＜0.05). Logistic regression showed that preoperative anticoagulant therapy (OR=4.551, P=0.006), high preoperative international standardized ratio (OR=2.964, P=0.004), intrathoracic adhesion (OR=4.560, P=0.000), low preoperative hemoglobin (OR=0.462, P=0.045) and long operation time (OR=6.106, P=0.000) were significantly associated with blood transfusion. The incidence of primary graft dysfunction (PGD) grade 3 (26.2% vs 10.9%, P=0.01) and mortality within 30 days after operation (32.3% vs 14.7%, P＜0.01) in the transfusion group were higher than those in the non-transfusion group.

  Conclusion  Preoperative anticoagulation therapy, low preoperative hemoglobin, high preoperative INR, intrathoracic adhesion and long operation time are risk factors of intraoperative transfusion. The prognosis of patients with blood transfusion is worse than that of patients without blood transfusion.