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Impact of preoperative right-ventricular function and platelet transfusion on outcome after lung transplantation

Zalunardo, Marco P. ; Thalmann, Caroline ; Seifert, Burkhardt ; D'Cunja, Jaya ; Weder, Walter ; Boehler, Annette ; Spahn, Donat R.

In: European Journal of Cardio-Thoracic Surgery, 2011, vol. 39, no. 4, p. 538-542

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    Title
    • Impact of preoperative right-ventricular function and platelet transfusion on outcome after lung transplantation
    Author
    • Zalunardo, Marco P.. Institute of Anaesthesiology, University Hospital Zürich, Rämistrasse 100, CH - 8091 Zürich, Switzerland
    • Thalmann, Caroline. Institute of Anaesthesiology, University Hospital Zürich, Rämistrasse 100, CH - 8091 Zürich, Switzerland
    • Seifert, Burkhardt. Biostatistics Unit, Institute of Social and Preventive Medicine, University of Zürich, Switzerland
    • D'Cunja, Jaya. Institute of Anaesthesiology, University Hospital Zürich, Rämistrasse 100, CH - 8091 Zürich, Switzerland
    • Weder, Walter. Division of Thoracic Surgery, Department of Surgery, University Hospital, Zürich, Switzerland
    • Boehler, Annette. Pulmonary Division, Department of Internal Medicine, University Hospital, Zürich, Switzerland
    • Spahn, Donat R.. Institute of Anaesthesiology, University Hospital Zürich, Rämistrasse 100, CH - 8091 Zürich, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • European Journal of Cardio-Thoracic Surgery, 2011, vol. 39, no. 4, p. 538-542. Elsevier Science B.V.
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:301979
    Summary
    Objective: Lung transplantation has become an established treatment option for end-stage pulmonary diseases. However, outcome depends on preoperative condition and co-morbidity. Furthermore, perioperative blood-product use is known to be associated with worse outcome even in transplant surgery. We investigated the impact of poor preoperative right-ventricular function and blood-product use on outcome after lung transplantation. Methods: The medical records of 169 lung-transplant recipients from 1996 to 2006 were examined. Duration of hospital stay, hours on mechanical ventilation, duration of stay in the intensive care unit, perioperative complications, death during hospital stay, and long-term survival were recorded. These outcome parameters were analyzed regarding coherence with right-ventricular function and the perioperative administration of crystalloids, colloids, allogeneic red blood cells, fresh frozen plasma, and platelets. Results: Patients with poor preoperative right-ventricular function had a significant increase in postoperative hours on ventilation (p=0.005), intensive care stay (p=0.003), and in-hospital death (p=0.012). The hours on ventilation increased also with high intra-operative fluid administration (p=0.026). Blood-product use was associated with prolonged mechanical ventilation and intensive care stay. After multivariate analysis, transfusion of platelets (p=0.022) was an independent prognostic factor for in-hospital death. Hours of mechanical ventilation was the only independent prognostic factor for long-term mortality (p=0.014). Conclusions: Perioperative transfusion of platelets is an independent prognostic factor for perioperative mortality. Furthermore, the study indicated that poor preoperative right-ventricular function might worsen perioperatively after lung transplantation. Therefore, pre-transplant treatment of pulmonary hypertension to protract right-ventricular failure and a restrictive use of allogeneic blood products may be options to improve outcome