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• W2040462021 abstract "Introduction: Blood product transfusion may contribute to overall morbidity and mortality in the intensive care unit patient population. In lung transplants necessitating cardiopulmonary bypass (CPB), aprotinin has been shown to decrease transfusion requirements. More recently, off-pump transplantation has become the standard of care. The efficacy of aprotinin use in this population has yet to be definitively examined. We postulate that aprotinin use during off-pump bilateral orthotopic lung transplantation (OP-BOLT) reduces peri-operative transfusions. Methods: We completed a retrospective review of all adult OP-BOLTs performed between January of 2000 and January of 2006 at a single university center (n = 195). The five most common preoperative diagnoses were included: chronic obstructive pulmonary disease (COPD, n = 84), cystic fibrosis (CF, n = 50), idiopathic pulmonary fibrosis (IPF, n = 47), and others, which included UIP, sarcoid, alpha-1 anti-trypsin deficiency and LAM (n = 14). Exclusion criteria included repeat lung transplantation, single lung transplantation, post-operative plasmapheresis and the use of cardiopulmonary bypass. Aprotinin use was determined by the attending anesthesiologist or surgeon. It was administered at the time of induction. The primary outcome was total blood product utilized in terms of units transfused during post-operative days 0, 1 and 2. Statistical analyses were performed using the Wilcoxon rank sum test. Results: Ninety-five patients received aprotinin and 99 did not. Clinical covariates were similar for both groups except for a lower preoperative hemoglobin level in CF patients who received aprotinin compared to CF patients who did not. An overall analysis of all of the patients in this study demonstrated a trend towards statistical significance for reduced total blood product transfusion for the aprotinin group compared to the non-aprotinin group (p = 0.13). Because of the recognized effect of diagnosis on recipient comorbidities and because COPD was the most common primary indication for this study, a subgroup analysis was performed in relationship to each diagnosis. The use of aprotinin was associated with a significant reduction in peri-operative total blood products transfused in COPD patients (p = 0.03) undergoing OP-BOLT. Conclusion: Although statistical significance was not reached in this study, there appears to be a trend towards a decreased administration of blood products in patients undergoing OP-BOLT if they received aprotinin peri-operatively. Moreover, a subgroup analysis demonstrated that the use of aprotinin in the COPD population did result in a statistically significant decrease in total blood products transfused, specifically the total number of units of packed red blood cells given. These findings suggest that aprotinin administration should be considered for all patients undergoing OP-BOLT to reduce exposure to blood products and potential immune sensitization and infectious complications." @default.
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• W2040462021 date "2008-02-01" @default.
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• W2040462021 title "QS5. Aprotinin Use Reduces Blood Product Transfusion in Off-Pump BOLT for COPD" @default.
• W2040462021 doi "https://doi.org/10.1016/j.jss.2007.12.242" @default.
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