• Theresa Seay, Nicole Guinn, Yasmin Maisonave, Matt Fuller, Jessica Poisson, Angela Pollak, Ben Bryner, John Haney, Jacob Klapper, Matthew Hartwig, and Brandi Bottiger.
• Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC. Electronic address: theresa.c.seay@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2020 Nov 1; 34 (11): 3024-3032.

ObjectivesLung transplantation is associated with a significant risk of needed transfusion. Although algorithm-based transfusion strategies that promote a high fresh frozen plasma:red blood cells (FFP:RBC) ratio have reduced overall blood product requirements in other populations, large-volume transfusions have been linked to primary graft dysfunction (PGD) in lung transplantation, particularly use of platelets and plasma. The authors hypothesized that in lung transplant recipients requiring large-volume transfusions, a higher FFP:RBC ratio would be associated with increased PGD severity at 72 hours.DesignObservational retrospective review.SettingSingle tertiary academic center.ParticipantsAdult patients undergoing bilateral or single orthotopic lung transplantation and receiving >4 U PRBC in the first 72 hours from February 2014 to March 2019.InterventionsNone.Measurements And Main ResultsPatient demographics, operative characteristics, blood transfusions, and outcomes including PGD scores and length of stay were collected. Eighty-nine patients received >4U PRBC, had available 72-hour PGD data, and were included in the study. These patients were grouped into a high-ratio (>1:2 units of FFP:RBC, N = 38) or low-ratio group (<1:2 units of FFP:RBC, N = 51). Patients in the high-ratio group received more transfusions and factor concentrates and had significantly longer case length. The high-ratio group had a higher rate of severe PGD at 72 hours (60.5% v 23.5%, p = 0.0013) and longer hospital length of stay (40 v 32 days, p = 0.0273).ConclusionsIn bleeding lung transplantation patients at high risk for PGD, a high FFP:RBC transfusion ratio was associated with worsened 72-hour PGD scores when compared with the low-ratio cohort.Copyright © 2020 Elsevier Inc. All rights reserved.

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