Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial
Abstract Background Primary graft dysfunction (PGD) after lung transplantation (LuTx) contributes substantially to early postoperative morbidity. Both intraoperative transfusion of a large amount of blood products during the surgery and ischemia–reperfusion injury after allograft implantation play a...
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| Language: | English |
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BMC
2023-03-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-023-02372-0 |
| _version_ | 1797865712821207040 |
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| author | Jaromir Vajter Jiri Vachtenheim Zuzana Prikrylova Jan Berousek Tomas Vymazal Robert Lischke Archer Kilbourne Martin Miroslav Durila |
| author_facet | Jaromir Vajter Jiri Vachtenheim Zuzana Prikrylova Jan Berousek Tomas Vymazal Robert Lischke Archer Kilbourne Martin Miroslav Durila |
| author_sort | Jaromir Vajter |
| collection | DOAJ |
| description | Abstract Background Primary graft dysfunction (PGD) after lung transplantation (LuTx) contributes substantially to early postoperative morbidity. Both intraoperative transfusion of a large amount of blood products during the surgery and ischemia–reperfusion injury after allograft implantation play an important role in subsequent PGD development. Methods We have previously reported a randomized clinical trial of 67 patients where point of care (POC) targeted coagulopathy management and intraoperative administration of 5% albumin led to significant reduction of blood loss and blood product consumption during the lung transplantation surgery. A secondary analysis of the randomized clinical trial evaluating the effect of targeted coagulopathy management and intraoperative administration of 5% albumin on early lung allograft function after LuTx and 1-year survival was performed. Results Compared to the patients in the control (non-POC) group, those in study (POC) group showed significantly superior graft function, represented by the Horowitz index (at 72 h after transplantation 402.87 vs 308.03 with p < 0.001, difference between means: 94.84, 95% CI: 60.18–129.51). Furthermore, the maximum doses of norepinephrine administered during first 24 h were significantly lower in the POC group (0.193 vs 0.379 with p < 0.001, difference between the means: 0.186, 95% CI: 0.105–0.267). After dichotomization of PGD (0–1 vs 2–3), significant difference between the non-POC and POC group occurred only at time point 72, when PGD grade 2–3 developed in 25% (n = 9) and 3.2% (n = 1), respectively (p = 0.003). The difference in 1-year survival was not statistically significant (10 patients died in non-POC group vs. 4 patients died in POC group; p = 0.17). Conclusions Utilization of a POC targeted coagulopathy management combined with Albumin 5% as primary resuscitative fluid may improve early lung allograft function, provide better circulatory stability during the early post-operative period, and have potential to decrease the incidence of PGD without negative effect on 1-year survival. Trial registration This clinical trial was registered at ClinicalTrials.gov (NCT03598907). |
| first_indexed | 2024-04-09T23:12:33Z |
| format | Article |
| id | doaj.art-fc079a4fc1f6404a8a31f6e5a9972c2a |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-04-09T23:12:33Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-fc079a4fc1f6404a8a31f6e5a9972c2a2023-03-22T10:19:11ZengBMCBMC Pulmonary Medicine1471-24662023-03-0123111310.1186/s12890-023-02372-0Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trialJaromir Vajter0Jiri Vachtenheim1Zuzana Prikrylova2Jan Berousek3Tomas Vymazal4Robert Lischke5Archer Kilbourne Martin6Miroslav Durila7Department of Anesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and University Hospital MotolPrague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University and University Hospital MotolDepartment of Anesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and University Hospital MotolDepartment of Anesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and University Hospital MotolDepartment of Anesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and University Hospital MotolPrague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University and University Hospital MotolDivision of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic College of Medicine and ScienceDepartment of Anesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and University Hospital MotolAbstract Background Primary graft dysfunction (PGD) after lung transplantation (LuTx) contributes substantially to early postoperative morbidity. Both intraoperative transfusion of a large amount of blood products during the surgery and ischemia–reperfusion injury after allograft implantation play an important role in subsequent PGD development. Methods We have previously reported a randomized clinical trial of 67 patients where point of care (POC) targeted coagulopathy management and intraoperative administration of 5% albumin led to significant reduction of blood loss and blood product consumption during the lung transplantation surgery. A secondary analysis of the randomized clinical trial evaluating the effect of targeted coagulopathy management and intraoperative administration of 5% albumin on early lung allograft function after LuTx and 1-year survival was performed. Results Compared to the patients in the control (non-POC) group, those in study (POC) group showed significantly superior graft function, represented by the Horowitz index (at 72 h after transplantation 402.87 vs 308.03 with p < 0.001, difference between means: 94.84, 95% CI: 60.18–129.51). Furthermore, the maximum doses of norepinephrine administered during first 24 h were significantly lower in the POC group (0.193 vs 0.379 with p < 0.001, difference between the means: 0.186, 95% CI: 0.105–0.267). After dichotomization of PGD (0–1 vs 2–3), significant difference between the non-POC and POC group occurred only at time point 72, when PGD grade 2–3 developed in 25% (n = 9) and 3.2% (n = 1), respectively (p = 0.003). The difference in 1-year survival was not statistically significant (10 patients died in non-POC group vs. 4 patients died in POC group; p = 0.17). Conclusions Utilization of a POC targeted coagulopathy management combined with Albumin 5% as primary resuscitative fluid may improve early lung allograft function, provide better circulatory stability during the early post-operative period, and have potential to decrease the incidence of PGD without negative effect on 1-year survival. Trial registration This clinical trial was registered at ClinicalTrials.gov (NCT03598907).https://doi.org/10.1186/s12890-023-02372-0Lung transplantationAnesthetic managementRotational thromboelastometryVolume replacement therapy5% albumin |
| spellingShingle | Jaromir Vajter Jiri Vachtenheim Zuzana Prikrylova Jan Berousek Tomas Vymazal Robert Lischke Archer Kilbourne Martin Miroslav Durila Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial BMC Pulmonary Medicine Lung transplantation Anesthetic management Rotational thromboelastometry Volume replacement therapy 5% albumin |
| title | Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial |
| title_full | Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial |
| title_fullStr | Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial |
| title_full_unstemmed | Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial |
| title_short | Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial |
| title_sort | effect of targeted coagulopathy management and 5 albumin as volume replacement therapy during lung transplantation on allograft function a secondary analysis of a randomized clinical trial |
| topic | Lung transplantation Anesthetic management Rotational thromboelastometry Volume replacement therapy 5% albumin |
| url | https://doi.org/10.1186/s12890-023-02372-0 |
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