Association between intraoperative fluid volume and 30-day mortality in patients undergoing lung transplantation: a retrospective cohort study.

Perioperative fluid management is crucial for maintaining circulatory stability and organ perfusion. Limited research has directly examined the relationship between intraoperative fluid volume and 30-day mortality in lung transplantation (LTx). This study aimed to investigate the independent effect of intraoperative fluid volume on 30-day postoperative mortality. We conducted a retrospective analysis of adult lung transplant recipients at The Second Affiliated Hospital of Zhejiang University School of Medicine. Four multivariable logistic regression models were employed to assess the associations between intraoperative fluid volume and its components with 30-day mortality. Subgroup analysis was performed stratified by age, pulmonary hypertension, preoperative extracorporeal membrane oxygenation (ECMO) support, transplant type, operative duration, and cold ischemia time. The study population comprised 375 patients, of whom 48 (12.8%) died within 30 days post-transplantation. Fluid administered intraoperatively was linked to 30-day mortality [odds ratio (OR) =2.70, 95% confidence interval (CI): 1.89-3.87, P<0.001]. Compared to the lowest quartile (Q1), patients in the highest quartile (Q4) had significantly higher 30-day mortality (OR =14.31, 95% CI: 3.63-56.38, P<0.001). Higher intraoperative volumes of crystalloids (OR =1.74, 95% CI: 1.13-2.67, P=0.01), red blood cells (RBCs) (OR =3.59, 95% CI: 1.94-6.65, P<0.001), and fresh frozen plasma (FFP) (OR =4.21, 95% CI: 2.13-8.31, P<0.001) were significantly associated with increased 30-day mortality. Intraoperative fluid volume was also associated with increased odds of grade 3 primary graft dysfunction (PGD), increased odds of acute kidney injury (AKI), prolonged mechanical ventilation, total intensive care unit (ICU) stay, and hospital stay. Our study demonstrates a significant association between intraoperative fluid volume and 30-day mortality following LTx. A more restrictive intraoperative fluid strategy may reduce the 30-day mortality and improve prognosis in lung transplant recipients.