Objective To investigate the impact of intraoperative red blood cell (RBC) transfusion volume on the postoperative oxygenation index in lung transplant recipients. Methods This retrospective study analyzed the clinical data of patients who underwent lung transplantation at Wuxi People's Hospital Affiliated to Nanjing Medical University from 2021 to 2023. Patients were divided into a non-severe primary graft dysfunction (PGD) group and a severe PGD group based on whether their postoperative oxygenation index was>200 mm Hg at 0, 24, and 48 h. General patient data and intraoperative RBC transfusion volumes were compared between the two groups. A binary logistic regression model was constructed to explore the effect size (OR and its 95%CI) of RBC transfusion volume on postoperative oxygenation status at different time points (0, 24, and 48 h). The area under the receiver operating characteristic curve was calculated to evaluate the model's diagnostic performance. Results A total of 351 patients were included (260 males, 91 females), with ages ranging from 20 to 77 years. The OR for the effect of intraoperative RBC transfusion on poor oxygenation was 1.486 (95%CI 0.982 to 2.248, P=0.061) at 0 h postoperatively, 3.111 (95%CI 1.793 to 5.399, P<0.001) at 24 h, and 1.583 (95%CI 1.026 to 2.442, P=0.038) at 48 h. This indicated that as time progressed, the postoperative oxygenation status of lung transplant recipients was affected by the intraoperative transfusion volume. Furthermore, an RBC transfusion volume>975 mLhad a significant impact on patient oxygenation at 24 and 48 h postoperatively. Conclusion The volume of intraoperative RBC transfusion has a significant impact on the oxygenation status at 24 and 48 h postoperatively. Intraoperative RBC transfusion volume is associated with the occurrence of severe PGD after lung transplantation. Controlling the volume of RBC transfusion during lung transplantation may help reduce the incidence of severe PGD.
ObjectiveTo systematically review the current status, technical evolution, and safety strategies of minimally invasive techniques in liver transplantation, and to analyze the core challenges and future directions of their application for both donors and recipients. MethodHigh-quality domestic and international research literature, including multi-center registry studies and meta-analyses, was integrated to comparatively analyze the clinical efficacy, safety, and limitations of open, laparoscopic, and robotic surgeries. ResultsFor donors, minimally invasive donor hepatectomy is relatively mature. Laparoscopic surgery, as an early exploratory technique, provides minimally invasive benefits but is limited by a steep learning curve and a higher risk of early biliary complications. Robotic surgery demonstrates superior performance in reducing open conversion rates and recipient biliary complications, but it faces considerable controversies, including high costs, prolonged operative time, and potential selection bias. For recipients, minimally invasive transplantation remains in the early feasibility exploration stage. Full robotic surgery is performed only in a few top-tier centers for highly selected patients with low model for end-stage liver disease score and no severe portal hypertension, with its technical and economical barriers and long-term safety yet to be validated. ConclusionsMinimally invasive techniques significantly improve donor perioperative outcomes, but their widespread adoption is constrained by stringent selection criteria, high medical costs, a steep learning curve, and a lack of high-quality long-term efficacy evidence. Future development relies on evidence accumulation from prospective multi-center registry studies and the establishment of standardized, localized training systems. At present, minimally invasive techniques are not the standard of care but represent an important therapeutic option that offers superior clinical outcomes for a select group of well-screened donors and recipients.