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Use of aprotinin in pediatric lung transplantation
R D Jaquiss1, C B Huddleston, T L Spray
1Department of Surgery, St. Louis Children's Hospital, Washington University School of Medicine, MO 63110, USA.
Insights
Aprotinin did not significantly reduce blood loss in pediatric lung transplant patients at high risk for bleeding. However, it appeared to normalize their transfusion needs to match lower-risk patients.
Area of Science:
- Cardiology
- Transplantation Surgery
- Pediatric Medicine
Background:
- Aprotinin is known to reduce perioperative bleeding in adult cardiac surgery.
- Its efficacy in pediatric lung transplantation has not been extensively studied.
Purpose of the Study:
- To evaluate the effectiveness of aprotinin in minimizing blood loss during pediatric lung transplantation.
- To compare bleeding outcomes in high-risk pediatric lung transplant recipients receiving aprotinin versus low-risk recipients not receiving the drug.
Main Methods:
- Aprotinin was administered to 24 high-risk pediatric lung transplant recipients (cystic fibrosis or prior cardiothoracic surgery).
- A control group of 19 low-risk pediatric recipients did not receive aprotinin.
- All procedures involved cardiopulmonary bypass.
Main Results:
- No significant differences were observed in intraoperative blood requirements between the groups.
- Postoperative transfusion needs and 24-hour chest tube output showed no significant variations.
- Reexploration for bleeding occurred in 8% of the aprotinin group and 16% of the control group, with no statistical difference.
Conclusions:
- Aprotinin demonstrated a potential to reduce perioperative hemorrhage in high-risk pediatric lung transplant patients.
- While not fully quantifiable, the drug's effect normalized transfusion requirements to levels seen in lower-risk patients.
Background:
Aprotinin has been shown to decrease perioperative bleeding in adults undergoing cardiac surgery. We evaluated its efficacy in reducing blood loss in pediatric lung transplantation.
Methods:
Aprotinin was given to a group of pediatric lung transplant recipients (n = 24) identified as being at high risk for bleeding by virtue of preoperative diagnosis of cystic fibrosis or previous cardiothoracic operation (group 1). Comparison was made to a group of pediatric recipients (n = 19) believed to be at low risk for bleeding who did not receive aprotinin (group 2). All transplantations were accomplished with the use of cardiopulmonary bypass.
Results:
No difference in intraoperative blood requirement was identified between groups (18 +/- 3 cc/kg [group 1] versus 30 +/- 8 cc/kg [group 2], p = 0.16). Neither postoperative blood transfusion requirement (12 +/- 5 cc/kg [group 1] versus 16 +/- 6 cc/kg [group 2], p = 0.55) nor chest tube output in the first 24 postoperative hours (43 +/- 9 cc/kg [group 1] versus 53 +/- 13 cc/kg [group 2], p = 0.55) was significantly different between groups. Reexploration for bleeding was required in 8% (2 of 25) in group 1 and 16% (3 of 19) in group 2 (p = 0.64).
Conclusions:
Aprotinin reduced the amount of perioperative hemorrhage in a group of pediatric patients at high risk for bleeding after lung transplantation. The magnitude of the effect could not be quantified but was sufficient to normalize the transfusion requirement to that of a low risk group of patients.