Are blood transfusions post lung transplant detrimental?

From the Guidelines

Blood transfusions post lung transplant should be avoided when possible and considered only at hemoglobin concentrations of 7 g/dL or less, or for symptoms such as chest pain, orthostatic hypotension, or tachycardia unresponsive to fluid resuscitation, due to the associated risks of rejection, infection, and mortality. The use of blood transfusions in post-lung transplant patients is a complex issue, with potential benefits and risks that must be carefully weighed. According to the clinical practice guideline from the AABB 1, transfusion should be considered at hemoglobin concentrations of 7 g/dL or less, or for symptoms such as chest pain, orthostatic hypotension, or tachycardia unresponsive to fluid resuscitation. Some key points to consider when evaluating the need for blood transfusions in lung transplant recipients include:

• The risk of transfusion-related acute lung injury (TRALI), which can be particularly dangerous for lung transplant patients
• The potential for immunological responses to transfused blood, which may increase the risk of rejection
• The standard risks of transfusion reactions, infection transmission, and fluid overload associated with blood transfusions
• The importance of using leukocyte-reduced blood products to minimize immune stimulation when transfusions are necessary The AABB guideline 1 is based on high-quality evidence from 19 trials involving 6264 patients, and recommends a restrictive transfusion strategy to minimize the risks associated with blood transfusions. Overall, while blood transfusions may be necessary in certain situations, such as severe anemia or significant blood loss, they should be used judiciously and with careful consideration of the potential risks and benefits in lung transplant recipients.

From the Research

Blood Transfusions Post Lung Transplant

• Blood transfusions post lung transplant have been associated with adverse outcomes, including primary graft dysfunction (PGD), increased mortality, and rejection 2, 3, 4, 5.
• Perioperative blood transfusions have been linked to a higher risk of PGD, longer mechanical ventilation days, and increased need for ECMO support 3.
• Transfused patients have been found to have a higher incidence of adverse events post-transplantation, including dialysis, stroke, and acute organ rejection before discharge 5.
• Red blood cell transfusion prior to lung transplantation has been associated with increased mortality risk and morbidity, but no significant difference in bronchiolitis obliterans syndrome development 5.
• The need for blood product transfusion during and after lung transplantation is common, but this practice may potentially be modifiable 2.

Risks and Complications

• Blood product transfusion has been associated with mortality and rejection in solid organ transplants, and predisposes to primary graft dysfunction (PGD) in lung transplant recipients 3, 4.
• Perioperative transfusions in lung transplant recipients have been found to increase the risk of PGD, ICU days, need for mechanical ventilation, and ECMO support 3.
• Transfusion requirements and blood bank support are crucial in lung transplantation, with platelets being the most frequently transfused blood component 6.

Management and Strategies

• Point-of-care coagulation testing and goal-directed transfusion strategies may help reduce transfusion requirements in lung transplantation 4.
• Periodic evaluation of transfusion requirements can facilitate the efficient management of blood products at the time of transplantation and help blood banks predict changes in blood requirements 6.