The incidence of venous thromboembolisms (VTE) remains high after lung transplant (LT) . The purpose of this study was to identify the incidence and potential risk factors of VTE in LT patients at a single center.
A retrospective analysis was conducted on 52 recipients between January and December 2008. Post-operative VTEs were identified based upon radiographic scans, venous doppler reports, and lung biopsies during the transplant admission. The following risk factors were assessed: pre-transplant diagnosis, functional status, cardiopulmonary bypass use, intraoperative or perioperative factor VII administration,post operative Extra Corporeal membrane Oxygenator (ECMO), use of deep vein thrombosis (DVT) prophylaxis, body mass index, and type of transplant(single vs double).
Patients were primarily male (71%) and Caucasian (56%) with a mean age of 56.3 ± 11.4 years. The most common pre transplant diagnoses were pulmonary fibrosis (PF) (46%) and chronic obstructive pulmonary disease (29%). The overall incidence of patients developing a VTE was 19.2% (n = 10). Four patients had a DVT alone (2 upper extremity/body), 3 patients had both a DVT and a pulmonary embolism (PE), and 3 patients had a PE alone. Of the 3 patients who had PE alone their postoperative course was complicated by lobar torsion, pulmonary venous anastamotic stenosis and Primary Graft Dysfunction requiring ECMO support.Patients with upper extremity/body DVT were associated with jugular triple lumen catheters or peripherally inserted central catheter placement. Mean time to development of a DVT was 7.7 ± 4.4 days. Of the variables assessed only pre-transplant diagnosis of PF was independently associated with VTE (p = 0.0164) while lack of DVT prophylaxis did not reach significance.
The incidence of VTE (19.2%)is high in LT population. Pre-transplant diagnosis of PF was identified as a risk factor for VTE. A larger sample size may be needed to validate these and other findings.
Patients with PF are at high risk for VTE. Surveillance for DVT prophylaxis,early ambulation and avoidance of procoagulant clotting factors like factor VII may prevent VTE.
Erin Elliott, No Financial Disclosure Information; No Product/Research Disclosure Information