Aprotinin therapy in heart and heart-lung transplantation

Patients who undergo cardiothoracic transplantation represent a considerable challenge to any blood conservation program. It is well recognized that excessive bleeding increases the mortality and morbidity rates of any surgical procedure, but patients who undergo heart and lung transplantation, either singly or in combination, have a greater probability of bleeding more frequently and to a greater extent than patients who undergo many other types of surgery. In addition to the problems inherent in excessive bleeding are those associated with the need for increased donor blood transfusion requirements in these procedures. In this regard it is imperative to avoid the transmission of any blood-borne infection to a patient who is immunosuppressed. In particular, the cytomegalovirus is a key problem. With large blood losses and in patients with uncommon blood groups, it may not be possible to guarantee unlimited supplies of cytomegalovirus-negative blood.