C47-25 Modifiable Risk Factors for the Development of Early Venous Thromboembolism After Lung Transplantation

Introduction Venous thromboembolism (VTE) is a frequent complication within 30 days after lung transplantation and is associated with increased morbidity and mortality. Understanding which patients are at increased risk and during what period post-transplant is important. The aim of this study is to evaluate if there are pre-transplant, intra-operative, or post-transplant risk factors that correlate with increased VTE within the first 30 days after lung transplantation. Methods We examined 227 lung transplant recipients at a single center between 2019-2023. Pre-transplant, intra-operative, and post-operative variables were compared between the VTE positive and negative cohorts. Clinical data, including radiological scans, were collected from the electronic medical record via manual chart extraction and placed into redcap. Categorical variables were analyzed using Chi-square tests and expressed as frequencies and percentages. Continuous variables were analyzed using Mann-Whitney U tests and expressed as median and interquartile ranges unless otherwise noted. All p values ≤0.05 were considered statistically significant. Results Of the 227 individuals included in the study, 53 (23.3%) developed VTE within the first 30 days following lung transplantation. The median time to VTE diagnosis was 11 days post-transplant. While comparative analysis between the thrombosis and no thrombosis groups identified body mass index (BMI) as a risk factor, other lesser-known risk factors were noted including combined heart and lung transplantation, donor smoking status, type of induction therapy, increased intraoperative use of blood products, and use of extracorporeal membrane oxygenation (ECMO). Higher pre-operative platelet counts trended toward significance in the VTE cohort, and elevated total bilirubin was seen in the thrombosis group after transplant and up to two weeks later but returned to normal by one month. VTE was also associated with prolonged time to extubation and increased total length of intensive care unit stay. Conclusion VTE occurs at a notably high incidence in the acute period following lung transplantation compared to other solid organ transplants, and its development is associated with increased morbidity and mortality. There are several modifiable risk factors associated with VTE in lung transplantation, and clinical practices can be adjusted to help reduce the overall incidence and impact of VTE in this population. However, further research is needed to determine the most effective prevention strategies and to clarify which risk factors are most critical to target in this population. This abstract is funded by: NYU Division of Pulmonary, Critical Care, and Sleep Medicine