Hydroxocobalamin for the treatment of vasoplegia after lung transplantation: A case series

TL;DR

This case series explores the use of hydroxocobalamin to treat vasoplegia in lung transplant patients, showing some improvement in blood pressure and reduced vasopressor use.

Contribution

The paper is the first to report hydroxocobalamin use for post-lung-transplant vasoplegia in humans.

Findings

Hydroxocobalamin increased mean arterial pressure in all three patients within 2 hours.

Patients 1 and 2 showed sustained improvements in blood pressure and reduced vasopressor use at 24 hours.

One patient developed methemoglobinemia and elevated triglycerides as side effects.

Abstract

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.

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.

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.

Hydroxocobalamin may be a valuable adjunct in managing refractory vasoplegia following lung transplantation.

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