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

Abstract

(1) Background: To examine the clinical characteristics and hospital outcomes of hospitalization for lung transplantation in COPD patients in Spain from 2016 to 2020; and to assess if the COVID 19 pandemic has affected the number or the outcomes of lung transplantations in these patients. (2) Methods: We used the Spanish National Hospital Discharge Database to select subjects who had a code for COPD (ICD-10: J44) and had undergone a lung transplantation (ICD-10 codes OBYxxxx). (3) Results: During the study period, 704 lung transplants were performed among COPD patients (single 31.68%, bilateral 68,32%). The absolute number of transplants increased with raising rates of 8%, 14% and 19% annually from 2016 to 2019. However, a marked decrease of -18% was observed from 2019 to year 2020. Overall, 47.44% of the patients suffered at least one complication, being the most frequent lung transplant rejection (24.15%), followed by lung transplant infection (13.35%). The median length of hospital stay (LOHS) was 33 days and the in-hospital-mortality (IHM) was 9.94%. Variables associated with increased risk of mortality were a Comorbidity Charlson Index ≥ 1 (OR 1.82; 95%CI 1.08–3.05) and suffering any complication of the lung transplantation (OR 2.14; 95%CI 1.27–3.6). COPD patients in 2020 had a CCI ≥ 1 in a lower proportion than 2019 patients (29.37 vs. 38.51%; p = 0.015) and less frequently suffered any complications after the lung transplantation (41.26 vs. 54.6%; p = 0.013), no changes in the LOHS or the IHM were detected from 2019 to 2020. (4) Conclusions: Our study showed a constant increase in the number of lung transplantations from 2016 to 2019 in COPD patients, with a drop from 2019 to 2020, probably related to the COVID-19 pandemic. However, no changes in LOHS or IHM were detected over time.

The impact of high volumes of COVID‐related lung transplant on waitlist mortality for non‐COVID candidates in the United States

“…This likely reflects the reduced urgency of these patients to proceed with transplant during the pandemic. 16 This trend was not observed for high volume COVID centers, nor did we observe an increase in waitlist times at high volume centers to suggest that transplant opportunities were being deferred for non-COVID candidates. We cannot, however, fully exclude the possibility that high volume COVID centers declined to list medically urgent non-COVID patients because of their number of COVID transplants.…”

“…Among all centers, the number of candidates added to the waitlist with the two most common obstructive lung diseases (COPD and A1AT) did decline. This likely reflects the reduced urgency of these patients to proceed with transplant during the pandemic 16 . This trend was not observed for high volume COVID centers, nor did we observe an increase in waitlist times at high volume centers to suggest that transplant opportunities were being deferred for non‐COVID candidates.…”