Catherine F Borders1, Yoshikazu Suzuki1, Jared Lasky1, Christian Schaufler1, Djamila Mallem1, James Lee2, Kevin Carney3, Scarlett L Bellamy4, Christian A Bermudez1, A Russell Localio4, Jason D Christie5, Joshua M Diamond2, Edward Cantu6. 1. Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa. 2. Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, Pa. 3. Transplant Institute, University of Pennsylvania, Philadelphia, Pa. 4. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pa. 5. Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, Pa; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pa. 6. Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa. Electronic address: edward.cantu@uphs.upenn.edu.
Abstract
OBJECTIVE: Donor blood transfusion has been identified as a potential risk factor for primary graft dysfunction and by extension early mortality. We sought to define the contributing risk of donor transfusion on early mortality for lung transplant. METHODS: Donor and recipient data were abstracted from the Organ Procurement and Transplantation Network database updated through June 30, 2014, which included 86,398 potential donors and 16,255 transplants. Using the United Network for Organ Sharing 4-level designation of transfusion (no blood, 1-5 units, 6-10 units, and >10 units, massive), we analyzed all-cause mortality at 30-days with the use of logistic regression adjusted for confounders (ischemic time, donor age, recipient diagnosis, lung allocation score and recipient age, and recipient body mass index). Secondary analyses assessed 90-day and 1-year mortality and hospital length of stay. RESULTS: Of the 16,255 recipients transplanted, 8835 (54.35%) donors received at least one transfusion. Among those transfused, 1016 (6.25%) received a massive transfusion, defined as >10 units. Those donors with massive transfusion were most commonly young trauma patients. After adjustment for confounding variables, donor massive transfusion was associated significantly with an increased risk in 30-day (P = .03) and 90-day recipient mortality (P = .01) but not 1-year mortality (P = .09). There was no significant difference in recipient length of stay or hospital-free days with respect to donor transfusion. CONCLUSIONS: Massive donor blood transfusion (>10 units) was associated with early recipient mortality after lung transplantation. Conversely, submassive donor transfusion was not associated with increased recipient mortality. The mechanism of increased early mortality in recipients of lungs from massively transfused donors is unclear and needs further study but is consistent with excess mortality seen with primary graft dysfunction in the first 90 days posttransplant.
OBJECTIVE:Donor blood transfusion has been identified as a potential risk factor for primary graft dysfunction and by extension early mortality. We sought to define the contributing risk of donor transfusion on early mortality for lung transplant. METHODS:Donor and recipient data were abstracted from the Organ Procurement and Transplantation Network database updated through June 30, 2014, which included 86,398 potential donors and 16,255 transplants. Using the United Network for Organ Sharing 4-level designation of transfusion (no blood, 1-5 units, 6-10 units, and >10 units, massive), we analyzed all-cause mortality at 30-days with the use of logistic regression adjusted for confounders (ischemic time, donor age, recipient diagnosis, lung allocation score and recipient age, and recipient body mass index). Secondary analyses assessed 90-day and 1-year mortality and hospital length of stay. RESULTS: Of the 16,255 recipients transplanted, 8835 (54.35%) donors received at least one transfusion. Among those transfused, 1016 (6.25%) received a massive transfusion, defined as >10 units. Those donors with massive transfusion were most commonly young traumapatients. After adjustment for confounding variables, donor massive transfusion was associated significantly with an increased risk in 30-day (P = .03) and 90-day recipient mortality (P = .01) but not 1-year mortality (P = .09). There was no significant difference in recipient length of stay or hospital-free days with respect to donor transfusion. CONCLUSIONS: Massive donor blood transfusion (>10 units) was associated with early recipient mortality after lung transplantation. Conversely, submassive donor transfusion was not associated with increased recipient mortality. The mechanism of increased early mortality in recipients of lungs from massively transfused donors is unclear and needs further study but is consistent with excess mortality seen with primary graft dysfunction in the first 90 days posttransplant.
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Authors: Joshua M Diamond; James C Lee; Steven M Kawut; Rupal J Shah; A Russell Localio; Scarlett L Bellamy; David J Lederer; Edward Cantu; Benjamin A Kohl; Vibha N Lama; Sangeeta M Bhorade; Maria Crespo; Ejigayehu Demissie; Joshua Sonett; Keith Wille; Jonathan Orens; Ashish S Shah; Ann Weinacker; Selim Arcasoy; Pali D Shah; David S Wilkes; Lorraine B Ware; Scott M Palmer; Jason D Christie Journal: Am J Respir Crit Care Med Date: 2013-01-10 Impact factor: 21.405
Authors: Alexis Slama; Laurens J Ceulemans; Celia Hedderich; Panja M Boehm; Jan Van Slambrouck; Stefan Schwarz; Christelle M Vandervelde; Markus Kamler; Peter Jaksch; Dirk Van Raemdonck; Konrad Hoetzenecker; Clemens Aigner Journal: Transpl Int Date: 2022-04-14 Impact factor: 3.842