<p>Trends and hospital outcomes of lung transplantation among patients with and without chronic obstructive pulmonary disease in Spain: a national population-based study (2001&ndash;2015)</p>

Abstract

Purpose To describe trends from 2001 to 2015 in incidence and in-hospital outcomes of patients suffering or not suffering from COPD who had undergone lung transplantation (LTx) in Spain. Methods We used the Spanish National Hospital Discharge Database to select all admissions for LTx. Incidence was estimated overall and according to the presence of COPD. Outcomes included infections, complications, length of hospital stay and in-hospital mortality (IHM). Results We identified 2,896 admissions for LTx. Admission rates rose in COPD sufferers and non-COPD sufferers over time, with higher rates among COPD patients. COPD and non-COPD patients were older, but mean age was higher in COPD patients. Although there was a male predominance among patients, the proportion of women significantly increased over time in the COPD population. COPD patients had lower Charlson Comorbidity Index values than non-COPD patients (score ≥1, 25.83% and 31.6%, P <0.05). We observed a significant increase in infections and complications of LTx or rejection for both groups over time. IHM decreased from 2001 to 2015 in both groups of patients. COPD was a predictor of lower IHM (OR 0.75, 95% CI 0.61–0.93) after LTx. Conclusion LTx-incidence rates were higher in COPD patients and increased over the study period in both groups. The proportion of women significantly increased over time among COPD sufferers. IHM decreased from 2001 to 2015 in both groups of patients. COPD was a predictor of lower mortality during admissions for LTx.

Time Trends in Clinical Characteristics and Hospital Outcomes of Hospitalizations for Lung Transplantation in COPD Patients in Spain from 2016 to 2020—Impact of the COVID-19 Pandemic

“…In our study, we observed a progressive increase in the number of lung transplantations from 2016 to 2019, following the trend observed in previous years [14]. The International Society for Heart and Lung Transplantation has also recently reported that the number of lung transplant recipients with COPD has also increased by era (1992-2000, 2001-2009, and 2010-2018), although the proportion of COPD recipients compared to other transplant diagnoses has decreased over time.…”

“…Factors independently associated with IHM in COPD patients after lung transplantation in our study were a higher comorbidity and suffering any complication of the lung transplantation. Both factors have been previously described as predictors of IHM, in addition to others such as age [14]. However, Bello et al, in a retrospective, multicenter cohort study that collected data from 272 adults with lung transplantation, also demonstrated an independent association between pulmonary graft disfunction and SOFA (Sequential Organ Failure Assessment) score with early mortality after lung transplant [34].…”

“…Furthermore, given the cross-sectional nature of our analyses, no causality can be established. Nonetheless, administrative databases, with their limitations, have been used in the past in Spain and other countries to assess time trends and outcomes of different transplants [14,[35][36][37][38][39][40][41][42][43][44]. In this regard, in the US, Fielding-Singh et al evaluated the accuracy of the National Inpatient Sample (NIS) by comparing estimates of solid organ transplantation to known national transplant volumes from the Organ Procurement and Transplant Network, concluding that although NIS transplantation research may be limited by the inability to subgroup procedures by donor type, surgical procedure coding of solid organ transplantation, the NIS appears to be accurate and reliable for generating national estimates [45].…”

“…Currently, there is limited literature on national trends in lung transplantation practices [12]. In Spain, there are studies indicating that hospitalization rates for lung transplantation increased significantly from 2001 to 2015 in COPD patients [13,14]. While there are few subsequent studies of trends, it appears that the COVID-19 pandemic caused a decrease in the mean number of lung transplantations in COPD and non-COPD subjects [15], as might have occurred in other countries [16,17].…”

Chronic Obstructive Pulmonary Disease and Lung Transplantation

“…1 In comparison to other disease groups, COPD graft recipients may demonstrate lower rates of in-hospital mortality than other groups, as suggested in a recent analysis of national databases in Spain over a 15-year period. 78 This appears to reflect the comparatively more stable candidate condition immediately prior to transplant.…”