Perioperative Lactate, Survival, and Complications Following Lung Transplantation

To examine perioperative lactate and its association with survival and postoperative complications following lung transplantation (LTx).

Single-center retrospective cohort study.

Academic tertiary-care transplant center.

Adult patients undergoing LTx between February 2018 and January 2023.

None.

Serum lactate was measured at 6-hour intervals from the start of surgery, and the maximum value within the first 0 to 6 hours was recorded. Patients were categorized into the high-lactate group (upper quartile, ≥4.2 mmol/L) and low-lactate group (lower 3 quartiles). Primary outcomes were 1-year and overall survival. Secondary outcomes included renal failure, venous thromboembolism (VTE), primary graft dysfunction grade 3 (PGD3), mechanical ventilation duration, intensive care unit (ICU) and post-transplant length of stay, and in-hospital mortality. Among 225 recipients (median age, 62.3 years; 34.2% female), high lactate was not associated with 1-year or overall survival. However, recipients with high lactate had higher rates of PGD3 at 72 hours (42.1% v 13.1%, p < 0.001), longer mechanical ventilation duration (3 days v 2 days, p = 0.003), longer ICU stay (11.6 days v 7 days, p = 0.013), and higher in-hospital mortality rate (7% v 0.6%, p = 0.019). No significant differences were observed in renal failure, VTE, or post-transplant length of stay.

Elevated perioperative serum lactate was associated with PGD3 at 72 hours, prolonged mechanical ventilation, longer ICU stay, and in-hospital mortality but not 1-year or overall survival following LTx. These findings suggest that perioperative lactate may aid in identifying high-risk patients early in their postoperative course despite its lack of association with long-term survival.