THE IMPACT OF INTRA-OPERATIVE THERAPEUTIC PLASMA EXCHANGE ON BLEEDING IN LUNG TRANSPLANTATION.

Our program uses a desensitization protocol that includes intraoperative therapeutic plasma exchange (iTPE) for crossmatch positive lung transplants, which improves access to lung transplant for sensitized candidates while mitigating immunologic risk. Although we have reported excellent outcomes for sensitized patients with the use of this protocol, concern for peri-operative bleeding appears to have hindered broader adoption of it at other programs. We conducted a retrospective cohort study to quantify the impact of iTPE on peri-operative bleeding in lung transplantation. All first-time lung transplant recipients from 2014-2019 who received iTPE were compared to those who did not. Multivariable logistic regression was used to determine the association between iTPE and large volume peri-operative transfusion requirements (≥5 packed red blood cell units within 24 hours of transplant start), adjusted for disease type, transplant type, and extracorporeal membrane oxygenation or cardiopulmonary bypass use. The incidence of hemothorax (requiring re-operation within 7 days of lung transplant) and 30-day post-transplant mortality were compared between the two groups using Chi square test. 142 patients (16%) received iTPE and 755 patients (84%) did not. The mean number of peri-operative pRBC transfusions was 4.2 among patients who received iTPE and 2.9 among patients who did not. iTPE was associated with an increased odds of requiring large volume peri-operative transfusion (OR 1.9; 95% CI: 1.2-2.9, p-value=0.007), but was not associated with an increased incidence of hemothorax (5% in both groups, p=0.99) or 30-day post-transplant mortality (3.5% among patients who received iTPE vs. 2.1% among patients who did not, p=0.31). This study demonstrates that the use of iTPE in lung transplantation may increase peri-operative bleeding, but not to a degree that impacts important post-transplant outcomes.

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