Massive donor transfusion potentially increases recipient mortality after lung transplantation

Abstract

Objective: Donor blood transfusion has been identified as a potential risk factor for primary graft dysfunction and by extension early mortality. We sought to define the contributing risk of donor transfusion on early mortality for lung transplant.

Methods: Donor and recipient data were abstracted from the Organ Procurement and Transplantation Network database updated through June 30, 2014, which included 86,398 potential donors and 16,255 transplants. Using the United Network for Organ Sharing 4-level designation of transfusion (no blood, 1-5 units, 6-10 units, and >10 units, massive), we analyzed all-cause mortality at 30-days with the use of logistic regression adjusted for confounders (ischemic time, donor age, recipient diagnosis, lung allocation score and recipient age, and recipient body mass index). Secondary analyses assessed 90-day and 1-year mortality and hospital length of stay.

Results: Of the 16,255 recipients transplanted, 8835 (54.35%) donors received at least one transfusion. Among those transfused, 1016 (6.25%) received a massive transfusion, defined as >10 units. Those donors with massive transfusion were most commonly young trauma patients. After adjustment for confounding variables, donor massive transfusion was associated significantly with an increased risk in 30-day (P = .03) and 90-day recipient mortality (P = .01) but not 1-year mortality (P = .09). There was no significant difference in recipient length of stay or hospital-free days with respect to donor transfusion.

Conclusions: Massive donor blood transfusion (>10 units) was associated with early recipient mortality after lung transplantation. Conversely, submassive donor transfusion was not associated with increased recipient mortality. The mechanism of increased early mortality in recipients of lungs from massively transfused donors is unclear and needs further study but is consistent with excess mortality seen with primary graft dysfunction in the first 90 days posttransplant.

Keywords: blood transfusion; lung transplantation.

Figure 1

Cause of death and number of blood transfusions (units) received CNS, central nervous system; CVA, cerebrovascular accident. Based on OPTN data as of September 5, 2014.

Figure 2

Displays comparative use of blood transfusions in lung donors that have received (0) no blood, (1) 1–5 units, (2) 6–10 units, (3) >10 units in both transplanted and discarded lungs. Based on OPTN data as of September 5, 2014.

Figure 3

30-day mortality risk Plots of predicted 30-day mortality risk of transplant recipients when given lungs from donors who have received no blood, 1–5 units, 6–10 units, and >10 units of blood. Bars depict predicted mortality by blood transfusion with 95% confidence intervals. Comparisons among groups demonstrated significant difference in risk between the no transfusion group and the >10 units group (p=0.03), all other comparisons were not significant. Based on OPTN data as of September 5, 2014.

Figure 4

Length of stay, conditional length of stay and Hospital free days Plots showing the length of stay a) overall; b) conditioned on 90-day survival; and 3) hospital free days in transplant recipients when given lungs from donors who have received no blood, 1–5 units, 6–10 units, >10 units of blood transfused. Lines display medians; error bars indicate interquartile ranges. Based on OPTN data as of September 5, 2014.