Use of aprotinin in pediatric lung transplantation

Background: Aprotinin has been shown to decrease perioperative bleeding in adults undergoing cardiac surgery. We evaluated its efficacy in reducing blood loss in pediatric lung transplantation. Methods: Aprotinin was given to a group of pediatric lung transplant recipients (n = 24) identified as being at high risk for bleeding by virtue of preoperative diagnosis of cystic fibrosis or previous cardiothoracic operation (group 1). Comparison was made to a group of pediatric recipients (n = 19) believed to be at low risk for bleeding who did not receive aprotinin (group 2). All transplantations were accomplished with the use of cardiopulmonary bypass. Results: No difference in intraoperative blood requirement was identified between groups (18 ± 3 cc/kg [group 1] versus 30 ± 8 cc/kg [group 2], p = 0.16). Neither postoperative blood transfusion requirement (12 ± 5 cc/kg [group 1] versus 16 ± 6 cc/kg [group 2], p = 0.55) nor chest tube output in the first 24 postoperative hours (43 ± 9 cc/kg [group 1] versus 53 ± 13 cc/kg [group 2], p = 0.55) was significantly different between groups. Reexploration for bleeding was required in 8% (2 of 25) in group 1 and 16% (3 of 19) in group 2 (p = 0.64). Conclusions: Aprotinin reduced the amount of perioperative hemorrhage in a group of pediatric patients at high risk for bleeding after lung transplantation. The magnitude of the effect could not be quantified but was sufficient to normalize the transfusion requirement to that of a low risk group of patients.