Lung Transplant With Cardiopulmonary Bypass: Impact of Blood Transfusion on Rejection, Function, and Late Mortality.

BACKGROUND: Allogeneic blood transfusion has been associated with immune modulation in other solid organ transplants. Within cardiothoracic surgery, allogeneic blood transfusion is associated with greater postoperative morbidity and mortality. We investigated the impact of allogeneic blood transfusion on rejection, function, and late mortality within lung transplantation. METHODS: A retrospective review was made of 311 adult patients who underwent bilateral lung transplantation with cardiopulmonary bypass from 2003 to 2013. Patients were stratified based on the amount of blood products transfused within 24 hours of transplantation. Kaplan-Meier methods and multivariate Cox proportional hazards models were used for time to first rejection/death and all-cause mortality analyses. RESULTS: In all, 174 men and 137 women (mean age 41.4 ± 14.0 years) utilized a median number of 3 units (range, 0 to 40) of red blood cells (RBC), 2 units (range, 0 to 26) of fresh frozen plasma (FFP), and 1 unit (range, 0 to 7) of platelets within the first 24 hours of transplantation. Time to first treated rejection/death was not statistically different whether patients were transfused with more or less than the median number of units of RBC (unadjusted p = 0.233, adjusted hazard ratio [HR] 1.02, 95% confidence interval [CI]: 0.75 to 1.40, p = 0.177), FFP (unadjusted p = 0.146, adjusted HR 1.29, 95% CI: 0.95 to 1.76, p = 0.108), or platelets (unadjusted p = 0.701, adjusted HR 0.74, 95% CI: 0.47 to 1.15, p = 0.177). Rate of rejection and number of rejection episodes per patient at 1 year after transplant were not statistically different. Forced expiratory volume in 1 second expressed as percentage of forced vital capacity at 3 and 6 months was similar for all groups. Unadjusted early all-cause mortality was not influenced by RBC (p = 0.162) or FFP (p = 0.298) but was significantly different with more platelets (p = 0.032). Adjusted 10-year mortality showed no significant differences for RBC (HR 1.12, 95% CI: 0.70 to 1.79, p = 0.645), FFP (HR 1.24, 95% CI: 0.78 to 1.97, p = 0.356), or platelets (HR 1.49, 95% CI: 0.84 to 2.64, p = 0.172.). CONCLUSIONS: All blood products administration regardless of amount transfused did not appear to affect early rejection outcomes or forced expiratory volume in 1 second expressed as percentage of forced vital capacity at 3 and 6 months. Use of RBC and FFP had no effect on survival. However, greater platelet usage appeared to adversely affect early but not late mortality.

Which is the best graft for the right coronary artery?

Bilateral internal mammary arteries directed to the left coronaries are gaining popularity; an increasing level of evidence nowadays supports this surgical strategy. On the other hand, composite right internal mammary artery, radial artery, and gastroepiploic artery targeting high-grade stenotic lesions in the right coronary artery system may confer improved mid- and long-term patency compared to long saphenous veins. This analysis looks into the evidence comparing data of the third best available conduit for grafting the right coronary artery, and by extrapolating this report, compares total arterial revascularization vs. conventional coronary artery bypass grafting.