Initial Postoperative Hemoglobin Values Are Independently Associated With One-Year Mortality in Patients Undergoing Double-Lung Transplantation Requiring Intraoperative Transfusion

High Rate of Passenger Lymphocyte Syndrome after ABO Minor Incompatible Lung Transplantation

Rationale: Passenger lymphocyte syndrome (PLS) may complicate minor ABO mismatched lung transplantation (LuTX) via donor-derived red cell antibody-induced hemolysis.Objectives: To ascertain the incidence and specificity of PLS-relevant antibodies among the study population as well as the dynamics of hemolysis parameters and the transfusion requirement of patients with or without PLS.Methods: In this cohort study, 1,011 patients who received LuTX between January 2010 and June 2019 were studied retrospectively. Prospectively, 87 LuTX (July 2019 to June 2021) were analyzed. Postoperative ABO antibody and hemolytic marker determinations, transfusion requirement, and duration of postoperative hospital care were analyzed. Retrospectively, blood group A recipients of O grafts with PLS were compared with those without.Measurements and Main Results: PLS affected 18.18% (retrospective) and 30.77% (prospective) of A recipients receiving O grafts, 5.13% of B recipients of O grafts, and 20% of AB patients receiving O transplants. Anti-A and anti-A1 were the predominant PLS-inducing antibodies, followed by anti-B and anti-A,B. Significantly lower hemoglobin values (median, 7.4 vs. 8.3 g/dl; P = 0.0063) and an approximately twice as high percentage of patients requiring blood transfusions were seen in PLS. No significant differences in other laboratory markers, duration of hospital stay, or other complications after LuTX were registered.Conclusions: Minor ABO incompatible LuTX recipients are at considerable risk of developing clinically significant PLS. Post-transplant monitoring combining red cell serology and hemolysis marker determination appears advisable so as not to overlook hemolytic episodes that necessitate antigen-negative transfusion therapy.

Follistatin-like 1 and Biomarkers of Neutrophil Activation Are Associated with Poor Short-Term Outcome after Lung Transplantation on VA-ECMO

The investigation of biomarkers associated with undesired outcome following lung transplantation (LuTX) is essential for a better understanding of the underlying pathophysiology, an earlier identification of susceptible recipients and the development of targeted therapeutic options. We therefore determined the longitudinal perioperative course of putative cytokines related to neutrophil activation (chemokine CC motif ligand 4 (CCL-4), interleukin (IL)-23 and Lipocalin 2 (LCN2)) and a cytokine that has been implicated in graft-versus-host disease (Follistatin-like 1 (FSTL1)) in 42 consecutive patients undergoing LuTX. We plotted receiver-operating curves (ROC) to assess the predictive power of the measured cytokines for short-term outcomes namely primary graft dysfunction (PGD), early complications requiring extracorporeal membrane oxygenation (ECMO), and a high postoperative sequential organ failure assessment (SOFA). All cytokines increased immediately after surgery. ROC analyses determined significant associations between CCL4 and a high SOFA score (area under the curve (AUC) 0.74 (95%CI:0.5−0.9; p < 0.05), between LCN2 and postoperative ECMO support (AUC 0.73 (95%CI:0.5−0.9; p < 0.05), and between FSTL1 and PGD (AUC 0.70 (95%CI:0.5−0.9; p < 0.05). The serum concentrations of the neutrophil-derived cytokines LCN2 and CCL4 as well as FSTL1 were all related to poor outcome after LuTX. The specific predictive power, however, still has to be assessed in larger trials. The potential role of FSTL1 as a biomarker in the development of PGD could be of great interest particularly since this protein appears to play a crucial role in allograft tolerance.

Gestational hypertriglyceridemia and adverse pregnancy outcomes: A search for cutoffs using generalized additive models

OBJECTIVE

To explore cutoffs of gestational hypertriglyceridemia based on the risk of adverse pregnancy outcomes.

METHODS

Pregnant women who visited National Taiwan University Hospital for prenatal care were included. Fasting plasma TG in the first and second trimesters were measured. Adverse pregnancy outcomes, including gestational diabetes and large for gestational age, were recorded and used in simple and multiple generalized additive models (GAM) to identify cutoffs for gestational hypertriglyceridemia.

RESULTS

We recruited 807 pregnant woman-newborn pairs. Using GAM analyses, we identified plasma TG at 95 or 140 mg/dL (1.07 or 1.58 mmol/L) in the first trimester, and 173 or 220 mg/dl (1.95 or 2.48 mmol/L) in the second trimester as potential cutoffs. Gestational hypertriglyceridemia defined by the higher cutoffs in both trimesters were associated with adverse pregnancy outcomes and had a more reasonable prevalence and better specificity than the lower cutoffs (First trimester plasma TG ≥ 140 mg/dL, adjusted OR 2.56, 95% CI 1.17-5.69, p = 0.019, prevalence 19%, specificity 83%; Second trimester plasma TG ≥ 220 mg/dL, adjusted OR 1.70, 95% CI 1.00-2.87, p = 0.049, prevalence 19%, specificity 81%).

CONCLUSIONS

Fasting plasma TG ≥ 140 mg/dL in the first trimester and ≥ 220 mg/dL in the second trimester can be used as cutoffs of gestational hypertriglyceridemia.