Risk factors and perioperative complications associated with deep venous thrombosis and pulmonary embolism after lung transplantation.

Background: Deep venous thrombosis (DVT) is common after lung transplantation, yet it can lead to serious complications, including pulmonary embolism (PE) and bleeding related to anticoagulation. The study aims to identify the risk factors for the development of DVT and PE to reduce the associated peri-operative complications. Methods: A retrospective review of the lung transplant database identified 399 consecutive patients who underwent lung transplantation from 2018 to 2024. The patient demographics, peri-postoperative factors, and outcomes were analyzed. Univariate and multivariate logistic regression analysis were used to predict PE in patients with DVT. Results: The incidence of DVT in the cohort was 53.6%. The patient with DVT had increased postoperative mortality (33.17% vs. 12.9%, P<0.001), development of PE (22.4% vs. 5.4%, P<0.001), hemothorax/hematoma (50.5% vs. 29.6%, P<0.001) and longer hospital stay (21 vs. 14 days, P<0.001) compared to patients without DVT. In the subgroup analysis, the patients with DVT who developed PE had more frequent lower extremity DVT than patients without PE (P=0.049). In the multivariate analysis, lung transplantation for pulmonary artery hypertension had a lower incidence of DVT [odds ratio (OR) 0.36, 95% confidence interval (CI): 0.17-0.80, P=0.01] and, among those with DVT, the lower extremity DVT (OR 2.14, 95% CI: 1.05-4.36, P=0.04) and elevated pre-operative platelet (OR 1.00, 95% CI: 1.00-1.01, P=0.046) was associated with a higher incidence of PE. The development of PE was not associated with an increased risk of mortality, but post-operative hemothorax or hematoma was. Conclusions: Postoperative DVT after lung transplant is associated with a significantly higher rate of complications such as bleeding and PE. The patients with lower extremity DVT and higher pre-operative platelet numbers had a higher risk for PE compared to patients with upper extremity DVT. Thus, the anticoagulation strategy may be modified based on these risk factors to prevent post-operative bleeding which carries a significant risk for mortality.