Development of New Donor-Specific and Human Leukocyte Antigen Antibodies After Transfusion in Adult Lung Transplantation

Sotatercept Use in a Patient with Pulmonary Arterial Hypertension Undergoing Lung Transplantation

Pulmonary arterial hypertension (PAH) is one of the common indications for lung transplantation. Sotatercept is a new medication with a novel mechanism of action and was recently approved for the treatment of PAH. Sotatercept is associated with significant adverse effects including thrombocytopenia and erythrocytosis which can impact outcomes of lung transplantation. This is the first described case of a patient undergoing lung transplantation while receiving sotatercept for PAH.

Perioperative Bleeding Risk in Lung Transplantation After Previous Cardiothoracic Surgery

INTRODUCTION

Previous cardiothoracic surgery (CTS) is associated with a significant risk of perioperative bleeding in lung transplantation (LT). The types of prior surgery have not been well-defined. We aimed to quantify the risk of perioperative bleeding in LT based on a history of previous CTS.

METHODS

We conducted a retrospective study of adult patients who underwent bilateral LT and stratified recipients into no prior CTS (No-CTS), minimally invasive CTS (Mi-CTS), or open/invasive CTS (I-CTS). The primary outcome was the occurrence of severe/massive bleeding or worse bleeding by the modified universal definition of perioperative bleeding (UDPB). Multivariable analysis was performed with p value <0.05 for statistical significance.

RESULTS

507 recipients were included. I-CTS had 3.93 higher odds of severe/massive bleeding (95% CI [1.98-7.98]; p < 0.001) and 4.37 higher odds of worse bleeding than No-CTS (95% CI [2.27-8.70]; p < 0.001). I-CTS had 2.38 higher odds of worse bleeding than Mi-CTS (95% CI [1.14-5.11]; p = 0.023). Mi-CTS had a higher risk of severe/massive bleeding and worse bleeding than No-CTS.

CONCLUSION

Patients with more invasive prior CTS had an increased risk of perioperative bleeding and worse outcomes. More invasive previous surgery predicts bleeding risk and requires more transfusion and hospital resources. Centers should examine opportunities for preoperative optimization, intraoperative management, and intraoperative extracorporeal life support (ECLS) strategies to mitigate this risk.

Effect of Therapeutic Plasma Exchange-Containing Regimens on Donor Specific Antibodies in Patients With Antibody Mediated Rejection of Pulmonary Transplant

Prior studies examining therapeutic plasma exchange (TPE)-containing regimens in pulmonary transplant antibody-mediated rejection (AMR) have been limited by sample size and inconsistent application of TPE. In this single-center, retrospective study, patients with pulmonary transplant AMR who received a TPE-containing treatment regimen were examined. Mean fluorescence intensity (MFI) and Class distribution of DSAs were examined before/after 5 TPE and again after 8 TPE in the subset of patients who received an extended course of TPE. Fifty-two patients who completed 5 TPE were included. Testing of serum at 1:1 and 1:16 prior to initiation of TPE demonstrated that Class II DSAs occurred more frequently and at a higher MFI compared to Class I DSAs. After completing 5 TPE, for both 1:1 and 1:16 testing, the MFI of DSAs decreased significantly regardless of Class. For 4 patients with persistent DSAs, extending the course of TPE to 8 procedures did not cause an additional significant decline in the MFI of DSAs. Four patients developed de novo DSAs during the course of 5 TPE. Development of de novo DSAs was not associated with plasma exposure during TPE and was associated with high morbidity. In conclusion, completion of 5 TPE during treatment for pulmonary transplant AMR is associated with significant declines in DSAs regardless of HLA Class. Extending the course of TPE for DSAs which persist despite 5 TPE may be of limited benefit. De novo development of DSAs during the course of 5 TPE is associated with poor outcomes.

Examining Bleeding Risk, Transfusion-related Complications, and Strategies to Reduce Transfusions in Lung Transplantation

Blood product transfusions for bleeding management in lung transplantation affect recipient outcomes. Interventions are needed to reduce perioperative bleeding risk and optimize outcomes.