Browse ATS 2021 Abstracts

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ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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Intraoperative Red Blood Cell Transfusion Is Associated with Primary Graft Dysfunction After Lung Transplantation

Session Title
TP23 - TP023 LUNG TRANSPLANT: OUTCOME PREDICTORS AND THERAPEUTIC OPTIONS
Abstract
A1785 - Intraoperative Red Blood Cell Transfusion Is Associated with Primary Graft Dysfunction After Lung Transplantation
Author Block: K. Subramaniam1, L. Gabriel2, B. Bottiger3, G. Warneckie4, H. Mathew5, D. Daoud6, W. Qi7, M. Villavicencio-Theoduloz8, S. Chandrasekharan9, T. Machuca10, V. Raemdonck11, A. Neyrinck12, Y. Toyoda13, M. Kashem14, S. Huddleston15, N. Ryssel16, F. Ius17, A. Osho18, M. Myers19, P. Sanchez20; 1Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, United States, 2Baylor College of Medicine, Houston, TX, United States, 3Anesthesiology and Perioperative Medicine, Duke University, Durham, NC, United States, 4Heidelberg University Hospital, Heidelberg, Germany, 5Surgery, Duke University, Durham, NC, United States, 6Surgery, Baylor College of Medicine, Houston, TX, United States, 7Biostatistics, Baylor College of Medicine, Houston, TX, United States, 8Cardiothoracic Surgery, Massachussets General Hospital, Boston, MA, United States, 9of Pulmonary Medicine, University of Florida, Gainesville, FL, United States, 10Surgery, University of Florida, Gainesville, FL, United States, 11Surgery, University of Leuven, Leuven, Belgium, 12Anesthesiology, University of Leuven, Leuven, Belgium, 13Surgery, Temple Univ Sch of Medicine, Philadelphia, PA, United States, 14Surgery, Temple University, Philadelphia, PA, United States, 15Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN, United States, 16Thoracic Transplant Surgery, University of Pittsburgh, Pittsburgh, PA, United States, 17Hannover Medical School, Hannover, Germany, 18Cardiac Surgery, Massachusetts General Hospital, Boston, MA, United States, 19University of Minnesota, Minneapolis, MN, United States, 20Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States.
Rationale. Primary graft dysfunction (PGD) after lung transplantation (LT) is associated with significant morbidity and mortality. Packed red blood cell (PRBC) transfusion has been described as one of the factors contributing to PGD. In this international, multicenter study of patients undergoing primary LT, we explored the association between intraoperative PRBC transfusion and occurrence of PGD grade 3 until 72 hours after LT. Methods. The Extracorporeal Life Support (ECLS) in LT registry includes data on bilateral LT patients from 9 high volume (>40 transplants/year) transplant centers (2 from Europe, 7 from United States). Adult patients who underwent LT from Jan 2016 through Nov 2020 with complete data on intraoperative PRBC transfusions were included. The primary outcome of interest was the occurrence of grade 3 PGD in the first 72 hours after LT. Other secondary outcomes analyzed in relation to PRBC transfusion included other postoperative organ system complications and mortality in the hospital, 90 days and at 1 year. LT recipients were divided into tertiles based on the amount of PRBC transfusion (0, 1-2 and > 2 units). Baseline donor variables, recipient characteristics, procedural variables and univariate outcomes were compared between the three groups by analysis of variance (ANOVA) and Chi-square tests as appropriate. Multiple logistic regression or analysis of covariance (ANCOVA) were utilized to establish the association between PRBC transfusion and patient outcomes adjusted for other covariates. Odds ratio and P- values were presented for the outcomes. Results. 729 patients with complete data from a cohort of 963 patients were included. Tertiles were significantly different in several preoperative and procedural characteristics (Table 1). Patients
receiving higher number of PRBCs (tertile 3) had more PGD and other complications by univariate analysis (Table 2). Multiple logistic regression performed adjusting for several significant covariates revealed increased incidence of PGD grade 3 within 72 hours (primary outcome), respiratory failure requiring tracheostomy and renal failure requiring dialysis in patients receiving higher number of PRBC transfusions (Table 2). Conclusion. In this study of a multicenter international registry of lung transplant patients, we have shown that intraoperative PRBC transfusion was associated with increased odds of grade 3 primary graft dysfunction within 72 hours, tracheostomy, renal failure requiring dialysis and greater length of stay. Whether efforts to reduce PRBC transfusion will translate into improved patient outcomes after lung transplant warrants further study.