Impact of Intraoperative Fluid Balance on Postoperative Clinical Outcomes after Single-Lung Transplantation.

PURPOSE: Single-lung transplantation (SLTx) recipients remain vulnerable to intraoperative fluid overload due to the presence of the native diseased lung. This study evaluated the impact of weight-adjusted intraoperative fluid balance on postoperative outcomes in brain-dead donor SLTx recipients.

METHODS

We analyzed 88 SLTx recipients categorized into low-fluid (<70 mL/kg; n = 44) and high-fluid (≥70 mL/kg; n = 44) groups based on the median (70.3 mL/kg). Multivariable logistic and linear regression analyses, with natural-log transformation of mechanical ventilation duration and ICU stay, were adjusted for operative duration, blood loss, and extracorporeal life support (ECLS) use.

RESULTS

Donor characteristics were comparable between groups. High fluid balance (≥70 mL/kg) was associated with significantly higher 48-hour primary graft dysfunction (PGD) Grade 3 rates (34.1% vs. 6.8%; P = 0.003), tracheostomy rates (36.4% vs. 9.1%; P = 0.004), longer mechanical ventilation (4 vs. 2 days; P = 0.016), and ICU stay (10 vs. 6 days; P = 0.011). Postoperative ECLS continuation at 48 hours was identical (2.3% vs. 2.3%). In multivariable analysis, high fluid balance remained significantly associated with 48-hour PGD Grade 3 (odds ratio: 4.91; P = 0.039).

CONCLUSION

A high intraoperative fluid balance was independently associated with severe 48-hour PGD Grade 3 following SLTx, supporting careful attention to intraoperative fluid balance in these patients.