Incidence of massive transfusion and overall transfusion requirements during lung transplantation over a 25-year period

Vladimir Cernak (Corresponding author), Annemieke Oude Lansink-Hartgring, Edwin R. van den Heuvel, Erik A.M. Verschuuren, Wim van der Bij, Thomas W.L. Scheeren, Gerwin E. Engels, Arian F. de Geus, Michiel E. Erasmus, Adrianus J. de Vries

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: To establish the incidence of massive transfusion and overall transfusion requirements during lung transplantation, changes over time, and association with outcome in relation to patient complexity. Design: Retrospective cohort study. Setting: University hospital. Participants: All 514 adult patients who underwent transplantation from 1990 until 2015. Interventions: None. Measurements and Main Results: Patient records and transfusion data, divided into 5-year intervals, were analyzed. The incidence of massive transfusion (>10 units of red blood cells [RBCs] in 24 h) was 27% and did not change over time, whereas the median (interquartile range) transfusion requirement in the whole cohort decreased from 8 (5-12) to 3 (0-10) RBCs (p < 0.001). In patients transplanted from the intensive care unit, the incidence of massive transfusion increased over time from 25% to 54% (p = 0.04) and median transfusion requirements from 4.5 (3-8.5) units to 14.5 (5-26) units of RBCs (p = 0.03). Multivariable analysis showed that circulatory support, pulmonary hypertension, re-transplantation, cystic fibrosis, Eisenmenger syndrome, bilateral transplantation, and low body mass index were associated with massive transfusion. Patients with massive transfusion had more primary graft dysfunction grade III at 0, 24, 48, and 72 hours (p < 0.001), higher 30-day mortality (13% v 4%; p < 0.001), and lower 5-year survival (hazard ratio 3.67 [95% confidence interval 1.72-7.85]; p < 0.001). Conclusion: The incidence of massive transfusion did not change over time, whereas transfusion requirements in the whole cohort decreased. In patients transplanted from the intensive care unit, massive transfusion and transfusion requirements increased. Massive transfusion was associated with poor outcome.

LanguageEnglish
Pages2478-2486
Number of pages9
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume33
Issue number9
DOIs
StatePublished - 1 Sep 2019

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Lung Transplantation
Incidence
Transplantation
Erythrocytes
Intensive Care Units
Primary Graft Dysfunction
Eisenmenger Complex
Pulmonary Hypertension
Cystic Fibrosis
Body Mass Index
Cohort Studies
Retrospective Studies
Confidence Intervals
Survival
Mortality

Keywords

  • lung transplantation
  • massive transfusion

Cite this

Cernak, V., Oude Lansink-Hartgring, A., van den Heuvel, E. R., Verschuuren, E. A. M., van der Bij, W., Scheeren, T. W. L., ... de Vries, A. J. (2019). Incidence of massive transfusion and overall transfusion requirements during lung transplantation over a 25-year period. Journal of Cardiothoracic and Vascular Anesthesia, 33(9), 2478-2486. DOI: 10.1053/j.jvca.2019.03.060
Cernak, Vladimir ; Oude Lansink-Hartgring, Annemieke ; van den Heuvel, Edwin R. ; Verschuuren, Erik A.M. ; van der Bij, Wim ; Scheeren, Thomas W.L. ; Engels, Gerwin E. ; de Geus, Arian F. ; Erasmus, Michiel E. ; de Vries, Adrianus J./ Incidence of massive transfusion and overall transfusion requirements during lung transplantation over a 25-year period. In: Journal of Cardiothoracic and Vascular Anesthesia. 2019 ; Vol. 33, No. 9. pp. 2478-2486
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abstract = "Objective: To establish the incidence of massive transfusion and overall transfusion requirements during lung transplantation, changes over time, and association with outcome in relation to patient complexity. Design: Retrospective cohort study. Setting: University hospital. Participants: All 514 adult patients who underwent transplantation from 1990 until 2015. Interventions: None. Measurements and Main Results: Patient records and transfusion data, divided into 5-year intervals, were analyzed. The incidence of massive transfusion (>10 units of red blood cells [RBCs] in 24 h) was 27{\%} and did not change over time, whereas the median (interquartile range) transfusion requirement in the whole cohort decreased from 8 (5-12) to 3 (0-10) RBCs (p < 0.001). In patients transplanted from the intensive care unit, the incidence of massive transfusion increased over time from 25{\%} to 54{\%} (p = 0.04) and median transfusion requirements from 4.5 (3-8.5) units to 14.5 (5-26) units of RBCs (p = 0.03). Multivariable analysis showed that circulatory support, pulmonary hypertension, re-transplantation, cystic fibrosis, Eisenmenger syndrome, bilateral transplantation, and low body mass index were associated with massive transfusion. Patients with massive transfusion had more primary graft dysfunction grade III at 0, 24, 48, and 72 hours (p < 0.001), higher 30-day mortality (13{\%} v 4{\%}; p < 0.001), and lower 5-year survival (hazard ratio 3.67 [95{\%} confidence interval 1.72-7.85]; p < 0.001). Conclusion: The incidence of massive transfusion did not change over time, whereas transfusion requirements in the whole cohort decreased. In patients transplanted from the intensive care unit, massive transfusion and transfusion requirements increased. Massive transfusion was associated with poor outcome.",
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Cernak, V, Oude Lansink-Hartgring, A, van den Heuvel, ER, Verschuuren, EAM, van der Bij, W, Scheeren, TWL, Engels, GE, de Geus, AF, Erasmus, ME & de Vries, AJ 2019, 'Incidence of massive transfusion and overall transfusion requirements during lung transplantation over a 25-year period' Journal of Cardiothoracic and Vascular Anesthesia, vol. 33, no. 9, pp. 2478-2486. DOI: 10.1053/j.jvca.2019.03.060

Incidence of massive transfusion and overall transfusion requirements during lung transplantation over a 25-year period. / Cernak, Vladimir (Corresponding author); Oude Lansink-Hartgring, Annemieke; van den Heuvel, Edwin R.; Verschuuren, Erik A.M.; van der Bij, Wim; Scheeren, Thomas W.L.; Engels, Gerwin E.; de Geus, Arian F.; Erasmus, Michiel E.; de Vries, Adrianus J.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 33, No. 9, 01.09.2019, p. 2478-2486.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Incidence of massive transfusion and overall transfusion requirements during lung transplantation over a 25-year period

AU - Cernak,Vladimir

AU - Oude Lansink-Hartgring,Annemieke

AU - van den Heuvel,Edwin R.

AU - Verschuuren,Erik A.M.

AU - van der Bij,Wim

AU - Scheeren,Thomas W.L.

AU - Engels,Gerwin E.

AU - de Geus,Arian F.

AU - Erasmus,Michiel E.

AU - de Vries,Adrianus J.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Objective: To establish the incidence of massive transfusion and overall transfusion requirements during lung transplantation, changes over time, and association with outcome in relation to patient complexity. Design: Retrospective cohort study. Setting: University hospital. Participants: All 514 adult patients who underwent transplantation from 1990 until 2015. Interventions: None. Measurements and Main Results: Patient records and transfusion data, divided into 5-year intervals, were analyzed. The incidence of massive transfusion (>10 units of red blood cells [RBCs] in 24 h) was 27% and did not change over time, whereas the median (interquartile range) transfusion requirement in the whole cohort decreased from 8 (5-12) to 3 (0-10) RBCs (p < 0.001). In patients transplanted from the intensive care unit, the incidence of massive transfusion increased over time from 25% to 54% (p = 0.04) and median transfusion requirements from 4.5 (3-8.5) units to 14.5 (5-26) units of RBCs (p = 0.03). Multivariable analysis showed that circulatory support, pulmonary hypertension, re-transplantation, cystic fibrosis, Eisenmenger syndrome, bilateral transplantation, and low body mass index were associated with massive transfusion. Patients with massive transfusion had more primary graft dysfunction grade III at 0, 24, 48, and 72 hours (p < 0.001), higher 30-day mortality (13% v 4%; p < 0.001), and lower 5-year survival (hazard ratio 3.67 [95% confidence interval 1.72-7.85]; p < 0.001). Conclusion: The incidence of massive transfusion did not change over time, whereas transfusion requirements in the whole cohort decreased. In patients transplanted from the intensive care unit, massive transfusion and transfusion requirements increased. Massive transfusion was associated with poor outcome.

AB - Objective: To establish the incidence of massive transfusion and overall transfusion requirements during lung transplantation, changes over time, and association with outcome in relation to patient complexity. Design: Retrospective cohort study. Setting: University hospital. Participants: All 514 adult patients who underwent transplantation from 1990 until 2015. Interventions: None. Measurements and Main Results: Patient records and transfusion data, divided into 5-year intervals, were analyzed. The incidence of massive transfusion (>10 units of red blood cells [RBCs] in 24 h) was 27% and did not change over time, whereas the median (interquartile range) transfusion requirement in the whole cohort decreased from 8 (5-12) to 3 (0-10) RBCs (p < 0.001). In patients transplanted from the intensive care unit, the incidence of massive transfusion increased over time from 25% to 54% (p = 0.04) and median transfusion requirements from 4.5 (3-8.5) units to 14.5 (5-26) units of RBCs (p = 0.03). Multivariable analysis showed that circulatory support, pulmonary hypertension, re-transplantation, cystic fibrosis, Eisenmenger syndrome, bilateral transplantation, and low body mass index were associated with massive transfusion. Patients with massive transfusion had more primary graft dysfunction grade III at 0, 24, 48, and 72 hours (p < 0.001), higher 30-day mortality (13% v 4%; p < 0.001), and lower 5-year survival (hazard ratio 3.67 [95% confidence interval 1.72-7.85]; p < 0.001). Conclusion: The incidence of massive transfusion did not change over time, whereas transfusion requirements in the whole cohort decreased. In patients transplanted from the intensive care unit, massive transfusion and transfusion requirements increased. Massive transfusion was associated with poor outcome.

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KW - massive transfusion

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DO - 10.1053/j.jvca.2019.03.060

M3 - Article

VL - 33

SP - 2478

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JO - Journal of Cardiothoracic and Vascular Anesthesia

T2 - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

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