Effect of epoprostenol-induced thrombocytopaenia on lung transplantation for pulmonary arterial hypertension.

Naoki Date, Daisuke Nakajima, Masaki Ikeda, Shigeto Nishikawa, Satona Tanaka, Yoshito Yamada, Yojiro Yutaka, Masatsugu Hamaji, Toshi Menju, Akihiro Ohsumi, Hiroshi Date

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2024 Mar 29

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Preoperative intravenous epoprostenol therapy can cause thrombocytopaenia, which may increase the risk of perioperative bleeding during lung transplantation. This study aimed to determine whether lung transplantation can be safely performed in patients with epoprostenol-induced thrombocytopaenia. From June 2008 to July 2022, we performed 37 lung transplants in patients with pulmonary arterial hypertension (PAH), including idiopathic PAH (n = 26), congenital heart disease-associated PAH (n = 7), pulmonary veno-occlusive disease (n = 3) and peripheral pulmonary artery stenosis (n = 1) at our institution. Of these, 26 patients received intravenous epoprostenol therapy (EPO group), whereas 11 patients were treated with no epoprostenol (no-EPO group). We retrospectively analysed the preoperative and postoperative platelet counts and post-transplant outcomes in each group. Preoperative platelet counts were relatively lower in the EPO group than in the no-EPO group (median EPO: 127 000 vs no-EPO: 176 000/μl). However, blood loss during surgery was similar between the 2 groups (EPO: 2473 ml vs no-EPO: 2615 ml). The platelet counts significantly increased over 1 month after surgery, and both groups showed similar platelet counts (EPO: 298 000 vs no-EPO: 284 000/μl). In-hospital mortality (EPO: 3.9% vs no-EPO: 18.2%) and the 3-year survival rate (EPO: 91.4% vs no-EPO: 80.8%) were similar between the 2 groups. Patients with PAH treated with intravenous epoprostenol showed relatively lower platelet counts, which improved after lung transplantation with good post-transplant outcomes. © The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Citation

Naoki Date, Daisuke Nakajima, Masaki Ikeda, Shigeto Nishikawa, Satona Tanaka, Yoshito Yamada, Yojiro Yutaka, Masatsugu Hamaji, Toshi Menju, Akihiro Ohsumi, Hiroshi Date. Effect of epoprostenol-induced thrombocytopaenia on lung transplantation for pulmonary arterial hypertension. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2024 Mar 29;65(4)