The review by Bottiger et al.1  highlights several recent studies related to allogenic transfusions for lung transplantation. The authors discuss perioperative factors that increase the risk of bleeding, report the evidence that connects transfusion to worse outcome, and suggest strategies to decrease transfusion. Many studies suggest an association between higher perioperative transfusion totals and primary graft dysfunction,2  which as the authors report is a problem encountered in 15 to 20% of lung transplants, but this association is complicated by multiple variables. Anesthesiologists should appreciate the evidence showing a connection between perioperative transfusion and lung transplantation outcome but also need to be aware of the additional factors involved in this issue.

The severity of primary graft dysfunction (grades 1 to 3) is based on the presence of infiltrates on chest x-ray, decreased ratio of arterial oxygen partial pressure (Pao2) to the fraction of inspired oxygen (Fio2...

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