Transfusion with packed red blood cells while awaiting lung transplantation is associated with reduced survival after lung transplantation

Background: The effect of pretransplant transfusion of red blood cells on survival after lung transplantation (LTx) has not been studied. Methods: The UNOS database was queried from 2005 to 2013 to compare survival in recipients receiving a transfusion while on the LTx wait list. Results: Of 12 283 adult patients undergoing single or bilateral LTx from May 2005 onwards, 11 801 met inclusion criteria, among whom 512 required transfusion while on the LTx wait list. Transfusion was associated with a higher mortality hazard in unadjusted Cox proportional hazards analysis (HR=1.296; 95% CI: 1.124, 1.494; P<.001), and in a multivariable Cox model (HR=1.178; 95% CI: 1.013, 1.369; P=.033) after multiple imputation was used to complete data on covariates. Propensity score matching was used to match transfusion recipients to nonrecipients on the likelihood of having received transfusions on the wait list, calculated from characteristics at the time of listing. Unadjusted Cox regression stratified on the matched pairs also demonstrated an association between transfusion receipt on the wait list and higher post-transplant mortality hazard (HR=1.494; 95% CI: 1.127, 1.979; P=.005). Conclusions: Blood transfusion while on the LTx wait list was associated with diminished patient survival after transplantation.