Intraoperative Red Blood Cell Transfusion and Primary Graft Dysfunction After Lung Transplantation

Kathirvel Subramaniam, Gabriel Loor, Ernest G. Chan, Brandi A. Bottiger, Fabio Ius, Matthew G. Hartwig, Daoud Daoud, Qianzi Zhang, Qi Wei, Mauricio A. Villavicencio-Theoduloz, Asishana A. Osho, Satish Chandrashekaran, Tiago Noguchi MacHuca, Dirk Van Raemdonck, Arne Neyrinck, Yoshiya Toyoda, Mohammed A. Kashem, Stephen Huddleston, Naomi R. Ryssel, Pablo G. Sanchez

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background. In this international, multicenter study of patients undergoing lung transplantation (LT), we explored the association between the amount of intraoperative packed red blood cell (PRBC) transfusion and occurrence of primary graft dysfunction (PGD) and associated outcomes. Methods. The Extracorporeal Life Support in LT Registry includes data on LT recipients from 9 high-volume (>40 transplants/y) transplant centers (2 from Europe, 7 from the United States). Adult patients who underwent bilateral orthotopic lung transplant from January 2016 to January 2020 were included. The primary outcome of interest was the occurrence of grade 3 PGD in the first 72 h after LT. Results. We included 729 patients who underwent bilateral orthotopic lung transplant between January 2016 and November 2020. LT recipient population tertiles based on the amount of intraoperative PRBC transfusion (0, 1-4, and >4 units) were significantly different in terms of diagnosis, age, gender, body mass index, mean pulmonary artery pressure, lung allocation score, hemoglobin, prior chest surgery, preoperative hospitalization, and extracorporeal membrane oxygenation requirement. Inverse probability treatment weighting logistic regression showed that intraoperative PRBC transfusion of >4 units was significantly (P < 0.001) associated with grade 3 PGD within 72 h (odds ratio [95% confidence interval], 2.2 [1.6-3.1]). Inverse probability treatment weighting analysis excluding patients with extracorporeal membrane oxygenation support produced similar findings (odds ratio [95% confidence interval], 2.4 [1.7-3.4], P < 0.001). Conclusions. In this multicenter, international registry study of LT patients, intraoperative transfusion of >4 units of PRBCs was associated with an increased risk of grade 3 PGD within 72 h. Efforts to improve post-LT outcomes should include perioperative blood conservation measures.

Original languageEnglish (US)
Pages (from-to)1573-1579
Number of pages7
Issue number7
StatePublished - Jul 1 2023

Bibliographical note

Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.

PubMed: MeSH publication types

  • Multicenter Study
  • Journal Article


Dive into the research topics of 'Intraoperative Red Blood Cell Transfusion and Primary Graft Dysfunction After Lung Transplantation'. Together they form a unique fingerprint.

Cite this