19 septembre 2025
341

Viscoelastic test during lung transplantation - The QuanTrans Multicentric Randomized Trial

Position du problème et objectif(s) de l’étude

Transfusion is frequent in lung transplantation despite improvements in surgical techniques. It is a deleterious risk factor for primary graft dysfunction, chronic rejection, and mortality. The main objective of this study is to determine if a transfusion algorithm based on whole blood viscoelastic test with Quantra® test reduces transfusion during lung transplantation compared to the protocol based on standard coagulation test.

Matériel et méthodes

We conducted a multicentric randomized clinical trial including patients undergoing double-lung transplantation between May 2023 and October 2024 at four hospitals in France. We excluded patients under cardiopulmonary bypass, preoperative ECMO, and multiorgan transplantation. Patients were randomized to either be managed based on the Quantra QPlus® Cartridge, or based on standard coagulation tests (PT, aPTT, or fibrinogen). The blood samples were measured at five surgical time points: on arrival at the operating room, after first pulmonary artery clamping, after first graft implantation, after second graft implantation, and at the end of surgery. Based on a historical cohort, the primary outcome was the reduction of 30% in the number of blood products (red blood cell packs and fresh frozen plasma) with a target of 7.95 (SD: 6.33). The protocol was registered in Clinical Trials (NCT05798286) and approved by the “Comité de Protection des Personnes Sud-Est V” (21.05392.210041-MS02).

Résultats & Discussion

Of the 128 patients included in the study, we randomized 55 in the Quantra group and 56 in the Standard group (mean age, 56 years [SD, 10 years]; 63% were male). Emphysema was the most common end-stage lung disease (54%), followed by pulmonary fibrosis (30%). There was no difference in the primary outcome, the number of intraoperative blood products transfused, 3.89+/- 6.96 in the Quantra group and 2.67 +/- 3.6 in the Standard group, p = 0.923. A post hoc analysis showed that 640 subjects would have been necessary to observe a significant difference. The results of our study reflect the global improvement and changes in clinical practice in transfusion during lung transplantation.

Conclusion

Patient blood management based on viscoelastic test with Quantra did not reduce the transfusion during double lung transplantation in this multicentric randomized control trial.

Auteurs

Julien FESSLER (1) , Benjamin REPUSSEAU (2), Aude CHARVET (3), Bertrand ROZEC (4), Aghiles SOUKI (1), Marc FISCHLER (1), Marc VASSE (1), Morgan LE GUEN (1), Tiffany PASCREAU (1) - (1)Hôpital Foch, Suresnes, France, (2)Chu Bordeaux, Bordeaux, France, (3)Aphm, Marseille, France, (4)Chu Nantes, Nantes, France

Orateur(s)

Julien FESSLER  (Suresnes)