Hospitalization Status at Time of Lung Transplant for Interstitial Lung Disease Does Not Affect Post Transplant Outcomes

Abstract

Purpose Hospitalization in advanced interstitial lung disease (ILD) patients awaiting lung transplant is common, but its association with post-transplant outcomes is unclear. Given that hospitalized patients are more seriously ill, immobilized and potentially experiencing an acute exacerbation, it may increase risk. Methods We performed a single center retrospective cohort study of 251 adult lung transplant recipients transplanted for ILD from January 1, 2004 to December 31, 2018, identifying those that were transplanted during hospitalization for severe respiratory failure or exacerbation. We used multivariable Cox regression to evaluate the association with post-transplant survival and chronic lung allograft dysfunction (CLAD) free survival, comparing hospitalized and non-hospitalized groups. We used multivariable logistic regression to study the association with grade 3 primary graft dysfunction (PGD) at 48/72 hours. Age and sex were added to each model a priori; other risk factors were added based on univariable analysis. Results 50/251 patients (19.9%) were hospitalized at time of transplant; all hospitalized patients had highest waitlist status. There was no association between hospitalization status and post-transplant survival in the crude (HR 0.98 (95% CI 0.59, 1.63), p=0.94) or multivariable analysis (HR 1.12 (95% CI 0.53, 2.39), p=0.76) after adjusting for age, sex, six minute walk distance, intra-operative circulatory support, body mass index, transplant era, ventilation or extra-corporeal life support bridge to transplant, and PaCO2. CLAD-free survival between the hospitalized and non-hospitalized groups were similar adjusting for age, sex, recipient-donor crossmatch, and transplant era (HR 1.44 (95% CI 0.67, 3.13), p=0.35). Likewise, PGD3 did not differ based on hospitalization status after adjustment for sex, age, bridging status, and donor age (OR 0.56 (95% CI 0.18-1.75) p=0.32). Conclusion Hospitalization status prior to transplant for ILD patients did not worsen post-transplant outcomes in our cohort, including post-transplant survival, CLAD-free survival and PGD development. These findings suggest that pre-transplant hospitalization does not increase the risk of adverse outcomes.