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

Onderzoeksoutput: Bijdrage aan tijdschriftTijdschriftartikelAcademicpeer review

Uittreksel

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.

TaalEngels
Pagina's2478-2486
Aantal pagina's9
TijdschriftJournal of Cardiothoracic and Vascular Anesthesia
Volume33
Nummer van het tijdschrift9
DOI's
StatusGepubliceerd - 1 sep 2019

Vingerafdruk

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

Trefwoorden

    Citeer dit

    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, Nr. 9. blz. 2478-2486
    @article{438ead5dcd084fa3992d37bd174e5184,
    title = "Incidence of massive transfusion and overall transfusion requirements during lung transplantation over a 25-year period",
    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.",
    keywords = "lung transplantation, massive transfusion",
    author = "Vladimir Cernak and {Oude Lansink-Hartgring}, Annemieke and {van den Heuvel}, {Edwin R.} and Verschuuren, {Erik A.M.} and {van der Bij}, Wim and Scheeren, {Thomas W.L.} and Engels, {Gerwin E.} and {de Geus}, {Arian F.} and Erasmus, {Michiel E.} and {de Vries}, {Adrianus J.}",
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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, nr. 9, blz. 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, Nr. 9, 01.09.2019, blz. 2478-2486.

    Onderzoeksoutput: Bijdrage aan tijdschriftTijdschriftartikelAcademicpeer 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.

    KW - lung transplantation

    KW - massive transfusion

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    U2 - 10.1053/j.jvca.2019.03.060

    DO - 10.1053/j.jvca.2019.03.060

    M3 - Article

    VL - 33

    SP - 2478

    EP - 2486

    JO - Journal of Cardiothoracic and Vascular Anesthesia

    T2 - Journal of Cardiothoracic and Vascular Anesthesia

    JF - Journal of Cardiothoracic and Vascular Anesthesia

    SN - 1053-0770

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    Cernak V, Oude Lansink-Hartgring A, van den Heuvel ER, Verschuuren EAM, van der Bij W, Scheeren TWL et al. Incidence of massive transfusion and overall transfusion requirements during lung transplantation over a 25-year period. Journal of Cardiothoracic and Vascular Anesthesia. 2019 sep 1;33(9):2478-2486. Beschikbaar vanaf, DOI: 10.1053/j.jvca.2019.03.060