Separate impact of perioperative recombinant human factor VIIa administration and packed red blood cell transfusions on mid-term survival in lung transplant recipients

Abstract Objective The purpose of this study is to determine the relationship between blood product transfusion with or without recombinant human activated factor VIIa and survival after lung transplant. Design Retrospective analysis of a single center with follow up out to 6 years post-transplant. Setting Single-center academic lung transplant program. Participants 265 adult patients who underwent single or bilateral sequential lung transplantation from March 2011 to June 2017. Interventions Overall survival using Kaplan-Meier curves was compared between three cohorts: those not transfused with blood products, those transfused with blood products, and those given blood products and recombinant human activated factor VIIa. Cox proportional hazards regression was used to estimate hazard ratios, confidence intervals and P-values. Results 78 patients received no packed red blood cell transfusions, 149 received packed red blood cell transfusions, and 38 received both packed red blood cell and recombinant human activated factor VII. Packed red blood cell transfusion was associated with increased risk of mortality that did not reach statistical significance (HR 2.168, CI 0.978-4.805, p=0.057). Additional packed red blood cells beyond 15 units are associated with worsened survival (HR 1.363, CI 1.137-1.633, p=0.001), but recombinant human activated factor VIIa did not increase risk of mortality. Conclusion Blood product transfusion during and after lung transplant is associated with decreased survival, especially with large volume transfusions. Survival is not worse with recombinant human activated factor VIIa administration, but further studies are needed to determine whether recombinant human activated factor VIIa administration reduces the need for blood product transfusions.