Incidence of Intraoperative Vasoplegic Syndrome in Lung Transplantation

Abstract

Objectives: Severe hypotension and low systemic vascular resistance in the setting of adequate cardiac output, known as "vasoplegic syndrome" (VS), is a physiologic disturbance reported in 9% to 44% of cardiac surgery patients. Although this phenomenon is well-documented in cardiac surgery, there are few studies on its occurrence in lung transplantation. The goal of this study was to characterize the incidence of VS in lung transplantation, as well as identify associated risk factors and outcomes.

Design: Retrospective study of single and bilateral lung transplants from April 2013 to September 2021.

Setting: The study was conducted at an academic hospital.

Participants: Patients ≥18 years of age who underwent lung transplantation.

Interventions: None.

Measurements and main results: The authors defined VS as mean arterial pressure <65 mmHg, cardiac index ≥2.2 L/min/m², and ≥30 minutes of vasopressor administration after organ reperfusion. The association between VS and risk factors or outcomes was assessed using t tests, Mann-Whitney U, and chi-square tests. The authors ran multivariate logistic regression models to determine factors independently associated with VS. The incidence of VS was 13.9% (CI 10.4%-18.4%). In the multivariate model, male sex (odds ratio 2.85, CI 1.07-7.58, p = 0.04) and cystic fibrosis (odds ratio 5.76, CI 1.43-23.09, p = 0.01) were associated with VS.

Conclusions: The incidence of VS in lung transplantation is comparable to that of cardiac surgery. Interestingly, male sex and cystic fibrosis are strong risk factors. Identifying lung transplant recipients at increased risk of VS may be crucial to anticipating intraoperative complications.

Keywords: bilateral lung transplantation; cardiopulmonary bypass; cardiothoracic anesthesia; cardiothoracic surgery; cystic fibrosis; lung transplantation; vasoplegia; vasoplegic syndrome.