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Venous Thromboembolism After Adult Lung Transplantation: A Frequent Event Associated With Lower Survival

Ribeiro Neto, Manuel, L., MD1,2; Budev, Marie, DO1; Culver, Daniel, A., DO1,3; Lane, C., Randall, MD1; Gomes, Marcelo, MD4; Wang, Xiao-Feng, PhD5; Rocha, Paulo, Novis, MD2; Olman, Mitchell, A., MD1,3

doi: 10.1097/TP.0000000000001977
Original Clinical Science—General

Background The incidence of venous thromboembolism (VTE) after lung transplantation (LTX) varies significantly across studies. Two studies have suggested that these thrombotic events are associated with a lower posttransplant survival. Herein, we sought to determine the incidence, predictors, and impact of VTE on survival after LTX at a quaternary referral center.

Methods This was a large cohort study of LTX recipients. Key outcome parameters were time to VTE after transplant and survival. Deep vein thrombosis (DVT) diagnosis required a positive ultrasound. Pulmonary embolism diagnosis required either a positive chest computed tomography angiogram or a high-probability ventilation/perfusion scan.

Results The overall incidence of VTE among 701 LTX recipients was 43.8%, of which 97.7% were DVT episodes, of which 71.3% were in the upper extremities. Predictors of VTE were prior history of DVT (hazard ratio [HR], 2.82; 95% confidence interval [CI], 1.49-5.37), days in intensive care (HR, 1.01; 95% CI, 1.01-1.02), and the use of extracorporeal membrane oxygenation (HR, 2.22; 95% CI, 1.43-3.45). Importantly, VTE predicted a lower posttransplant survival (HR, 1.70; 95% CI, 1.28-2.26), when occurring within or after the first 30 days. The location of the DVT, either upper extremity or below the knee, also predicted a poor survival.

Conclusions VTE was frequent in LTX recipients and predicted a poor survival even when located in the upper extremities or below the knee. These data suggest that aggressive VTE screening/treatment protocols be implemented in post-LTX population.

Venous thromboembolism (VTE) after lung transplantation is frequent and predicts a poor survival and the major predictors of VTE are prior history of DVT, days in intensive care, and the use of extracorporeal membrane oxygenation. Aggressive VTE screening/treatment is recommended.

1 Respiratory Institute, Cleveland Clinic, Cleveland, OH.

2 Health Sciences Postgraduate Program, Federal University of Bahia, Ondina, Salvador, Bahia, Brazil.

3 Lerner Research Institute, Cleveland Clinic, Cleveland, OH.

4 Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.

5 Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.

Received 3 May 2017. Revision received 12 September 2017.

Accepted 19 September 2017.

The authors declare no conflicts of interest.

This study was in part supported by NIH grants HL119792 and HL103553 to M.A.O.

M.L.R.N. participated in the research question development, in the research methods development, in the data analysis, and in the article review process. M.L.R.N. is the guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article. M.B. participated in research methods development, in extracting data from the lung transplant database, and in the article review process. D.A.C. participated in the research methods development and in the article review process. C.R.L. participated in the research methods development and in the article review process. M.G. participated in extracting data from the ultrasound database and in the article review process. X.W. participated in the data analysis and in the article review process. P.N.R. participated in the data analysis and in the article review process. M.A.O. participated in the research question development, in the research methods development, in the data analysis, and in the article review process.

Correspondence: Manuel L. Ribeiro Neto, MD, Cleveland Clinic, Respiratory Institute, 9500 Euclid Ave., A90, Cleveland, OH 44195. (ribeirm@ccf.org).

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