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Impact of Intraoperative Fluid Balance on Postoperative Clinical Outcomes after Single-Lung Transplantation
Ken Onodera1, Tatsuaki Watanabe1, Yusuke Takei2
1Department of Thoracic Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan.
Purpose:
Single-lung transplantation (SLTx) recipients remain vulnerable to intraoperative fluid overload due to the presence of the native diseased lung. This study evaluated the impact of weight-adjusted intraoperative fluid balance on postoperative outcomes in brain-dead donor SLTx recipients.
Methods:
We analyzed 88 SLTx recipients categorized into low-fluid (<70 mL/kg; n = 44) and high-fluid (≥70 mL/kg; n = 44) groups based on the median (70.3 mL/kg). Multivariable logistic and linear regression analyses, with natural-log transformation of mechanical ventilation duration and ICU stay, were adjusted for operative duration, blood loss, and extracorporeal life support (ECLS) use.
Results:
Donor characteristics were comparable between groups. High fluid balance (≥70 mL/kg) was associated with significantly higher 48-hour primary graft dysfunction (PGD) Grade 3 rates (34.1% vs. 6.8%; P = 0.003), tracheostomy rates (36.4% vs. 9.1%; P = 0.004), longer mechanical ventilation (4 vs. 2 days; P = 0.016), and ICU stay (10 vs. 6 days; P = 0.011). Postoperative ECLS continuation at 48 hours was identical (2.3% vs. 2.3%). In multivariable analysis, high fluid balance remained significantly associated with 48-hour PGD Grade 3 (odds ratio: 4.91; P = 0.039).
Conclusion:
A high intraoperative fluid balance was independently associated with severe 48-hour PGD Grade 3 following SLTx, supporting careful attention to intraoperative fluid balance in these patients.
