Background. Primary graft dysfunction (PGD) is a predominant cause of early morbidity and
mortality after lung transplantation. Although substantial work has been done to understand risk factors for PGD in terms of donor, recipient, and surgical factors, little is understood regarding the potential role of anaesthetic management variables in its development.
Methods. We conducted a retrospective exploratory analysis of 107 consecutive lung transplants to determine if anaesthesia factors were associated with early graft function quantified by PaO2/FIO2. Multivariate regression techniques were used to explore the association between anaesthetic management variables and PaO2/FIO2 ratio 12 h after operation. The relationship between these variables and both time to tracheal extubation and intensive care unit (ICU) length of stay was further examined using the Cox proportional hazards.
Results. On multivariate analysis, increasing volume of intraoperative colloid, comprising predominantly Gelofusinew (succinylated gelatin), was independently associated with a lower PaO2/FIO2 12 h post-transplantation [b coefficient 242 mm Hg, 95% confidence interval (CI) 27 to 277 mm Hg, P¼0.02] and reduced rate of extubation [hazard ratio (HR) 0.65, 95% CI 0.49–0.84, P¼0.001]. There was a trend for intraoperative colloid to be associated with a reduced rate of ICU discharge (HR 0.79, 95% CI 0.31–1.02, P¼0.07).
Conclusions. We observed an inverse relationship between volume of intraoperative colloid
and early lung allograft function. The association persists, despite detailed sensitivity analyses and adjustment for potential confounding variables. Further studies are required to confirm these findings and explore potential mechanisms through which these associations may act.