Transfusion-Related Acute Lung Injury (TRALI) and Transfusion-Associated Circulatory Overload (TACO) in Liver Transplantation: A Case Report and Focused Review

Abstract

Liver transplantation (LT) is a complex procedure in a patient with multi-organ system dysfunction and coagulation defects. The surgical procedure involves dissection, major vessel manipulation, and pathophysiologic effects of graft storage and reperfusion. As a result, LT frequently involves significant hemorrhage. Subsequent massive transfusion carries high risk of transfusion-associated complications. Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the leading causes of transfusion associated mortality. In this case report and focused review, we present data that suggest that patients undergoing liver transplantation may be at higher risk for TRALI and TACO than the general population. Anesthesiologists can play a role in decreasing these risks by increasing recognition and reporting of TRALI and TACO, using point of care testing with thromboelastography to guide and decrease transfusion, and considering alternatives to traditional blood products like solvent/detergent plasma.

Keywords

hemorrhage reperfusion coagulopathy critical care intraoperative assessment point of care monitoring

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References

Food and Drug Administration; Center for Biologics Education and Research. Fatalities reported to FDA following blood collection and transfusion. https://www.fda.gov/downloads/BiologicsBloodVaccines/SafetyAvailability/ReportaProblem/TransfusionDonationFatalities/UCM518148.pdf. Accessed September 22, 2017.

Bolton-Maggs

Cohen

Serious hazards of transfusion (SHOT) haemovigilance and progress is improving transfusion safety. Br J Haematol. 2013;163:303-314. doi:10.1111/bjh.12547.

Toy

Lowell

TRALI—definition, mechanisms, incidence and clinical relevance. Best Pract Res Clin Anaesthesiol. 2007;21:183-193. doi:10.1016/j.pestbp.2011.02.012.

Kleinman

Caulfield

Chan

, et al. Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel. Transfusion. 2004;44:1774-1789.

Silliman

McLaughlin

NJ.

Transfusion-related acute lung injury. Blood Rev. 2006;20:139-159. doi:10.1016/j.blre.2005.11.001.

Triulzi

DJ.

Transfusion-related acute lung injury: current concepts for the clinician. Anesth Analg. 2009;108:770-776. doi:10.1213/ane.0b013e31819029b2.

Bux

Sachs

UJ.

The pathogenesis of transfusion-related acute lung injury (TRALI). Br J Haematol. 2007;136:788-799. doi:10.1111/j.1365-2141.2007.06492.x.

Toy

Gajic

Bacchetti

, et al. Transfusion-related acute lung injury : incidence and risk factors. Blood. 2012;119:1757-1768. doi:10.1182/blood-2011-08-370932.

Nakazawa

Ohnishi

Okazaki

, et al. Impact of fresh-frozen plasma from male-only donors versus mixed-sex donors on postoperative respiratory function in surgical patients: a prospective case-controlled study. Transfusion. 2009;49:2434-2441. doi:10.1111/j.1537-2995.2009.02321.x.

10.

Sachs

Wasel

Bayat

, et al. Mechanism of transfusion-related acute lung injury induced by HLA class II antibodies. Blood. 2011;117:669-677. doi:10.1182/blood-2010-05-286146.

11.

Silliman

Paterson

Dickey

, et al. The association of biologically active lipids with the development of transfusion-related acute lung injury: a retrospective study. Transfusion. 1997;37:719-726. doi:10.1046/j.1537-2995.1997.37797369448.x.

12.

Silliman

Voelkel

Allard

, et al. Plasma and lipids from stored packed red blood cells cause acute lung injury in an animal model. J Clin Invest. 1998;101:1458-1467. doi:10.1172/JCI1841.

13.

Silliman

Boshkov

Mehdizadehkashi

, et al. Transfusion-related acute lung injury : epidemiology and a prospective analysis of etiologic factors. Blood. 2003;101:454-462. doi:10.1182/blood-2002-03-0958.

14.

Middelburg

van der Bom

JG.

Transfusion-related acute lung injury not a two-hit, but a multicausal model. Transfusion. 2015;55:953-960. doi:10.1111/trf.12966.

15.

Middelburg

van der Bom

JG.

TRALI not a two hit, but a multi-causal model. In: Mokrá

, ed. Acute Lung Injury: Epidemiology, Health Effects and Therapeutic Treatment Strategies. New York, NY: Nova Science; 2014.

16.

Rosendaal

FR.

Venous thrombosis: a multicausal disease. Lancet. 1999;353:1167-1173. doi:10.1016/S0140-6736(98)10266-0.

17.

Eder

Herron

Strupp

, et al. Transfusion-related acute lung injury surveillance (2003-2005) and the potential impact of the selective use of plasma from male donors in the American Red Cross. Transfusion. 2007;47:599-607. doi:10.1111/j.1537-2995.2007.01102.x.

18.

Gajic

Rana

Winters

, et al. Transfusion-related acute lung injury in the critically ill: prospective nested case-control study. Am J Respir Crit Care Med. 2007;176:886-891. doi:10.1164/rccm.200702-271OC.

19.

Sher

Markowitz

. TRALI risk mitigation for plasma and whole blood for allogeneic transfusion. Association Bulletin #14-02. Bethesda, MD: AABB; 2014:1-14.

20.

Clifford

Jia

Subramanian

, et al. Characterizing the epidemiology of postoperative transfusion-related acute lung injury. Anesthesiology. 2015;122:12-20.

21.

Mazzeffi

Tanaka

Transfusion-related acute lung injury: more questions than answers ?

Anesthesiology. 2015;123:488-489.

22.

Benson

Austin

Berg

, et al. Transfusion-related acute lung injury in ICU patients admitted with gastrointestinal bleeding. Intensive Care Med. 2010;36:1710-1717. doi:10.1007/s00134-010-1954-x.

23.

Snowden

Hughes

Rose

Roberts

DR.

Pulmonary edema in patients after liver transplantation. Liver Transpl. 2000;6:466-470. doi:10.1053/jlts.2000.7580.

24.

Spencer Yost

Matthay

Gropper

MA.

Etiology of acute pulmonary edema during liver transplantation: a series of cases with analysis of the edema fluid. Chest. 2001;119:219-223. doi:10.1378/chest.119.1.219.

25.

Aduen

Stapelfeldt

Johnson

, et al. Clinical relevance of time of onset, duration, and type of pulmonary edema after liver transplantation. Liver Transpl. 2003;9:764-771. doi:10.1053/jlts.2003.50103.

26.

Jiang

Peng

Yang

DH.

Effect of perioperative fluid therapy on early phase prognosis after liver transplantation. Hepatobiliary Pancreat Dis Int. 2008;7:367-372.

27.

de Boer

Christensen

Asmussen

, et al. The impact of intraoperative transfusion of platelets and red blood cells on survival after liver transplantation. Anesth Analg. 2008;106:32-44. doi:10.1213/01.ane.0000289638.26666.ed.

28.

Pereboom

de Boer

Haagsma

Hendriks

HGD

Lisman

Porte

RJ.

Platelet transfusion during liver transplantation is associated with increased postoperative mortality due to acute lung injury. Anesth Analg. 2009;108:1083-1091. doi:10.1213/ane.0b013e3181948a59.

29.

Lin

Cai

Jiang

Lü

Zhang

Cai

QC.

Perioperative risk factors for pulmonary complications after liver transplantation. J Int Med Res. 2010;38:1845-1855.

30.

Benson

Burton

Jr Austin

, et al. Differential effects of plasma and red blood cell transfusions on acute lung injury and infection risk following liver transplantation. Liver Transpl. 2011;17:149-158. doi:10.1002/lt.22212.

31.

Feltracco

Carollo

Barbieri

Pettenuzzo

Ori

Early respiratory complications after liver transplantation. World J Gastroenterol. 2013;19:9271-9281. doi:10.3748/wjg.v19.i48.9271.

32.

Morita

Pretto

Jr.

Increased incidence of transfusion-related acute lung injury during orthotopic liver transplantation: a short report. Transplant Proc. 2014;46:3593-3597. doi:10.1016/j.transproceed.2014.09.153.

33.

The Acute Respiratory Distress Syndrome Network; Brower

Matthay

Morris

Schoenfeld

Thompson

Wheeler

. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301-1308. doi:10.1056/NEJM200005043421801.

34.

Tsai

Chou

Yang

MW.

Perioperative transfusion-related acute lung injury: a retrospective analysis. Acta Anaesthesiol Taiwan. 2012;50:96-100. doi:10.1016/j.aat.2012.08.005.

35.

Bartelmaos

Chabanel

Léger

, et al. Plasma transfusion in liver transplantation: a randomized, double-blind, multicenter clinical comparison of three virally secured plasmas. Transfusion. 2013;53:1335-1345. doi:10.1111/j.1537-2995.2012.03895.x.

36.

Bindi

Miccoli

Marietta

, et al. Solvent detergent vs. fresh frozen plasma in cirrhotic patients undergoing liver transplant surgery: a prospective randomized control study. Vox Sang. 2013;105:137-143. doi:10.1111/vox.12021.

37.

Sachs

Kauschat

Bein

White blood cell-reactive antibodies are undetectable in solvent/detergent plasma. Transfusion. 2005;45:1628-1631. doi:10.1111/j.1537-2995.2005.00587.x.

38.

Görlinger

Saner

FH.

Prophylactic plasma and platelet transfusion in the critically ill patient: just useless and expensive or even harmful?

BMC Anesthesiol. 2015;15:86. doi:10.1186/s12871-015-0074-0.

39.

Durila

Lukáš

Astraverkhava

Beroušek

Zábrodský

Vymazal

Tracheostomy in intensive care unit patients can be performed without bleeding complications in case of normal thromboelastometry results (EXTEM CT) despite increased PT-INR: a prospective pilot study. BMC Anesthesiol. 2015;15:89. doi:10.1186/s12871-015-0073-1.

40.

Lisman

Porte

RJ.

Rebalanced hemostasis in patients with liver disease : evidence and clinical consequences. Blood. 2010;116:878-885. doi:10.1182/blood-2010-02-261891.

41.

Chi

Wei

Gao

, et al. Dexmedetomidine ameliorates acute lung injury following orthotopic autologous liver transplantation in rats probably by inhibiting toll-like receptor 4-nuclear factor kappa B signaling. J Transl Med. 2015;13:190. doi:10.1186/s12967-015-0554-5.

42.

Ortiz-Diaz

Festic

Gajic

Levitt

JE.

Emerging pharmacological therapies for prevention and early treatment of acute lung injury. Semin Respir Crit Care Med. 2013;34:448-458. doi:10.1055/s-0033-1351118.

43.

International Society on Blood Transfusion Working Party on Haemovigilance. Proposed standard definitions for surveillance of non infectious adverse transfusion reactions: July 2011 Incoroparting correction on TRALI definition (as adopted June 2013). http://www.isbtweb.org/fileadmin/user_upload/Proposed_definitions_2011_surveillance_non_infectious_adverse_reactions_haemovigilance_incl_TRALI_correction_2013.pdf. Accessed September 22, 2017.

44.

Raval

Mazepa

Russell

Immel

Whinna

Park

YA.

Passive reporting greatly underestimates the rate of transfusion-associated circulatory overload after platelet transfusion. Vox Sang. 2015;108:387-392. doi:10.1111/vox.12234.

45.

Shaz

Hillyer

Roshal

Abrams

CS.

Transfusion Medicine and Hemostasis: Clinical and Laboratory Aspects. 2nd ed. Amsterdam, Netherlands: Elsevier; 2009.

46.

Kojima

Nishisako

Sato

A patient with possible TRALI who developed pulmonary hypertensive crisis and acute pulmonary edema during cardiac surgery. J Anesth. 2012;26:460-463. doi:10.1007/s00540-011-1320-3.

47.

Murphy

Kwaan

Looney

, et al. Risk factors and outcomes in transfusion-associated circulatory overload. Am J Med. 2013;126:357.e29-357.e38. doi:10.1016/j.amjmed.2012.08.019.

48.

Roubinian

Hendrickson

Triulzi

, et al. Incidence and clinical characteristics of transfusion-associated circulatory overload using an active surveillance algorithm. Vox Sang. 2017;112:56-63. doi:10.1111/vox.12466.