Hydroxocobalamin for the treatment of vasoplegia after lung transplantation: A case series
Background: The use of hydroxocobalamin following lung transplantation has not been previously reported. We present a series of 3 cases where hydroxocobalamin was used to treat postoperative vasoplegia. Methods: We conducted a single-center, retrospective review of lung transplantation recipients fr...
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Elsevier
2025-02-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133424001381 |
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| author | Anh Nguyen, MD, PhD Rima Bouajram, PharmD Marek Brzezinski, MD Sahand Hassanipour David Gordon Binh Trinh, MD Tobias Deuse, MD Aida Venado, MD Steve Hays, MD Jonathan Singer, MD Jasleen Kukreja, MD, MPH |
| author_facet | Anh Nguyen, MD, PhD Rima Bouajram, PharmD Marek Brzezinski, MD Sahand Hassanipour David Gordon Binh Trinh, MD Tobias Deuse, MD Aida Venado, MD Steve Hays, MD Jonathan Singer, MD Jasleen Kukreja, MD, MPH |
| author_sort | Anh Nguyen, MD, PhD |
| collection | DOAJ |
| description | Background: The use of hydroxocobalamin following lung transplantation has not been previously reported. We present a series of 3 cases where hydroxocobalamin was used to treat postoperative vasoplegia. Methods: We conducted a single-center, retrospective review of lung transplantation recipients from January 2016 to December 2020. We used cumulative vasopressor index to standardize vasopressor dose administered and mean arterial pressure at 2- and 24-hour time-points following hydroxocobalamin administration to assess treatment effectiveness. Results: We identified 3 male patients aged 49 to 62, with lung allocation scores between 89.9 and 90.6, requiring extracorporeal membrane oxygenation support (pre- and post-transplant for 5, 5, 9 and 8, 2, 2 days, respectively). Each patient received hydroxocobalamin 5,000 mg infused over 15 minutes, with patient #3 receiving an additional 6 doses over the subsequent 4 days. At the 2-hour time-point, mean arterial pressure increased in all patients (+11%, +17%, and +13%, respectively), although cumulative vasopressor indexes were inconsistent. At 24 hours, patients #1 and #2 demonstrated a marked increase in mean arterial pressure (36% and 23%, respectively) and a decrease in cumulative vasopressor index, while patient #3 displayed stable with slight reduction in cumulative vasopressor index and mean arterial pressure values. No allergic reactions were observed. Patient #3 developed methemoglobinemia and a medication-related false increase in triglycerides. All 3 patients were discharged home. Conclusions: Hydroxocobalamin may be a valuable adjunct in managing refractory vasoplegia following lung transplantation. |
| format | Article |
| id | doaj-art-cba3434e3d0940cd96a0dfe8d4b6599c |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-cba3434e3d0940cd96a0dfe8d4b6599c2025-02-09T05:01:58ZengElsevierJHLT Open2950-13342025-02-017100189Hydroxocobalamin for the treatment of vasoplegia after lung transplantation: A case seriesAnh Nguyen, MD, PhD0Rima Bouajram, PharmD1Marek Brzezinski, MD2Sahand Hassanipour3David Gordon4Binh Trinh, MD5Tobias Deuse, MD6Aida Venado, MD7Steve Hays, MD8Jonathan Singer, MD9Jasleen Kukreja, MD, MPH10Baylor College of Medicine, Houston, Texas; Corresponding author: Anh Nguyen, MD, PhD, Baylor College of Medicine, Houston, Texas.University of California San Francisco, San Francisco, CaliforniaUniversity of California San Francisco, San Francisco, CaliforniaUniversity of California San Francisco, San Francisco, CaliforniaUniversity of California San Francisco, San Francisco, CaliforniaUniversity of California San Francisco, San Francisco, CaliforniaUniversity of California San Francisco, San Francisco, CaliforniaUniversity of California San Francisco, San Francisco, CaliforniaUniversity of California San Francisco, San Francisco, CaliforniaUniversity of California San Francisco, San Francisco, CaliforniaUniversity of California San Francisco, San Francisco, CaliforniaBackground: The use of hydroxocobalamin following lung transplantation has not been previously reported. We present a series of 3 cases where hydroxocobalamin was used to treat postoperative vasoplegia. Methods: We conducted a single-center, retrospective review of lung transplantation recipients from January 2016 to December 2020. We used cumulative vasopressor index to standardize vasopressor dose administered and mean arterial pressure at 2- and 24-hour time-points following hydroxocobalamin administration to assess treatment effectiveness. Results: We identified 3 male patients aged 49 to 62, with lung allocation scores between 89.9 and 90.6, requiring extracorporeal membrane oxygenation support (pre- and post-transplant for 5, 5, 9 and 8, 2, 2 days, respectively). Each patient received hydroxocobalamin 5,000 mg infused over 15 minutes, with patient #3 receiving an additional 6 doses over the subsequent 4 days. At the 2-hour time-point, mean arterial pressure increased in all patients (+11%, +17%, and +13%, respectively), although cumulative vasopressor indexes were inconsistent. At 24 hours, patients #1 and #2 demonstrated a marked increase in mean arterial pressure (36% and 23%, respectively) and a decrease in cumulative vasopressor index, while patient #3 displayed stable with slight reduction in cumulative vasopressor index and mean arterial pressure values. No allergic reactions were observed. Patient #3 developed methemoglobinemia and a medication-related false increase in triglycerides. All 3 patients were discharged home. Conclusions: Hydroxocobalamin may be a valuable adjunct in managing refractory vasoplegia following lung transplantation.http://www.sciencedirect.com/science/article/pii/S2950133424001381hydroxocobalaminvasoplegialung transplantationmean arterial pressurecummulative vasopressor index |
| spellingShingle | Anh Nguyen, MD, PhD Rima Bouajram, PharmD Marek Brzezinski, MD Sahand Hassanipour David Gordon Binh Trinh, MD Tobias Deuse, MD Aida Venado, MD Steve Hays, MD Jonathan Singer, MD Jasleen Kukreja, MD, MPH Hydroxocobalamin for the treatment of vasoplegia after lung transplantation: A case series JHLT Open hydroxocobalamin vasoplegia lung transplantation mean arterial pressure cummulative vasopressor index |
| title | Hydroxocobalamin for the treatment of vasoplegia after lung transplantation: A case series |
| title_full | Hydroxocobalamin for the treatment of vasoplegia after lung transplantation: A case series |
| title_fullStr | Hydroxocobalamin for the treatment of vasoplegia after lung transplantation: A case series |
| title_full_unstemmed | Hydroxocobalamin for the treatment of vasoplegia after lung transplantation: A case series |
| title_short | Hydroxocobalamin for the treatment of vasoplegia after lung transplantation: A case series |
| title_sort | hydroxocobalamin for the treatment of vasoplegia after lung transplantation a case series |
| topic | hydroxocobalamin vasoplegia lung transplantation mean arterial pressure cummulative vasopressor index |
| url | http://www.sciencedirect.com/science/article/pii/S2950133424001381 |
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