9,5

5,6

7,4

8,5

2

44

6

0123456789

10

1992-1996 1997-2001 2002-2006 2007-20011

mean

median

36

18

32

26

0

5

10

15

20

25

30

35

40

10 +

1992-1996

1997-2001

2002-2006

2007-2011

813

21

33

05

101520253035404550

0

1992-1996

1997-2001

2002-2006

2007-2011

Lung transplantation (LTX) is associated with excessive bleeding followed by massive red blood cell (RBC) transfusions1. However, little is known about blood use during LTX and there is almost no literature about changes in transfusion practice over time.

0

5

10

15

20

25

30

35

1992-1996 1997-2001 2002-2006 2007-2011

20 +

Transfusion records and mortality data of all LTX patients at University Medical Center Groningen were reviewed from 1992 until January 2012. This 20 year time period was stratified in 5 year intervals. We looked at blood use and specifically identified patients transplanted with no RBC and more than 10 units (10+) RBC in first 24 hours. In the last group we also identified patients with excessive transfusion requirement (more than 20 units). We estimated the overall 30 day mortality and compared the mortality rates in patients with no RBC and 10+ RBC.

We identified 429 patients with single or double LTX. Over the study period the mean number of RBC units did not change significantly. However the median number of units of RBC per patient decreased (Fig1). We have found that the proportion of patients transplanted without any transfusion of RBC increased over the time intervals (Fig2). The proportion of patient with 10+ RBC did not change (Fig3). In the last time interval the proportion of patients with 20+ RBC increased significantly (Fig4).

The use of 10+ RBC was associated with the intraoperative use of cardiopulmonary bypass and with specific diagnosis (both p<0.001). Pulmonary hypertension, cystic fibrosis, Eisenmenger syndrome and retransplantation accounted for 63% of patients transplanted with more than 10 RBC.

Overall 30 day mortality was 7.5%, but 1.1% if no RBC were used and 15% if 10+ RBC were used (p<0.001).

Over 20 year of lung transplantation the number of patients with no need for blood transfusions during first 24 hours after LTX increased. However, the proportion of patients with more than 10 RBC remained unchanged and the proportion of patients with excessive blood transfusion demands is even raised in last 5 year period . This could explain why the mean number of units per patient stayed unaffected while the median is decreased. In our study population we found that the amount of RBC transfusions was significantly associated with 30 day mortality. Therefore patients with the pulmonary hypertension, cystic fibrosis, Eisenmenger syndrome and retransplantation require careful selection and intraoperative management.

Introduction

Methods

Results

Fig1. Mean and median RBC units per patient in time.

Fig.2. Proportion of patients transplanted without blood transfusion in time

Fig.3. Proportion of patients transplanted with more than 10 IU of RBC in time

Fig.4. Proportion of patients with 10+ RBC that received more than 20 IU of RBC

Conclusion

1. Wang et al.: Multiple variables affecting blood usage in lung transplantation. JHLT Vol. 25, N 5, p.533-538

Blood transfusion demands in 429 consecutive lung transplantation patients over 20 year period in a single

centre.V Cernak, EAM Verschuuren, ME Erasmus, F Ismael, AJ de Vries

Department of Critical Care, University Medical Center Groningen, University of Groningen,The Netherlands