Prediction, incidence, and outcomes of massive transfusion during lung transplantation

Massive transfusion (MT) during lung transplantation (LT) may significantly impact the risk of perioperative complications and mortality. Currently, there are few studies examining the risk factors and prognosis associated with MT in LT. This study aims to investigate the incidence, risk factors, and outcomes of MT during LT procedures.

This retrospective study analyzed adult patients who underwent LT at The Second Affiliated Hospital of Zhejiang University School of Medicine from February 2020 to March 2022. MT was defined as the administration of ≥10 units of red blood cells (RBCs) during LT. Univariate and multivariate logistic regression analyses were conducted to evaluate the impact of preoperative risk factors on MT. The predictive accuracy of risk factors was assessed using the area under the receiver operating characteristic curve (AUC). Survival data were analyzed using Kaplan-Meier survival analysis. Cox survival analysis was employed to identify factors associated with patient survival.

A total of 144 patients were included in the analysis, of whom 75 (52.1%) received RBC transfusions during LT surgery, and 15 (10.4%) received MT. Multivariate analysis revealed that low body mass index (BMI) and low preoperative hematocrit (Hct) were independent risk factors for MT (P<0.05). The MT group was associated with prolonged surgical duration, increased plasma and platelet transfusion volumes, and decreased urine output (P<0.05). Furthermore, the MT group demonstrated significantly higher requirements for postoperative continuous renal replacement therapy (CRRT) (53.3% vs. 13.8%, P<0.001) and elevated 30-day mortality (53.3% vs. 14.7%, P<0.001). Through Cox proportional hazards modeling, MT was determined to be an independent prognostic factor for 30-day mortality [hazard ratio (HR) =5.13; 95% confidence interval (CI): 2.22-11.84; P<0.001].

MT during LT is not uncommon and is strongly associated with adverse outcomes. Low BMI and low preoperative Hct are significant predictors of MT. Preoperative optimization of nutritional status and correction of anemia may help reduce intraoperative transfusion requirements, thereby improving outcomes for LT recipients.