Trends, Outcomes, and Predictors of Acute In-hospital Stroke after Lung Transplantation: An Analysis of the United Network for Organ Sharing Database

Abstract

INTRODUCTION: Lung transplantation is the gold standard treatment for end-stage lung failure. We sought to characterize the impact of strokes on mortality and identify factors which were associated with stroke. METHODS: We identified adult (≥18 years old) first-time, isolated lung transplant (LTx) recipients from the United Network for Organ Sharing database between 5/2005 and 12/2020. Stroke was defined as occurring at any time after LTx but prior to discharge. Cox proportional hazards analysis was used to identify predictors of death at 24 months. Freedom from death in stroke vs non-stroke was evaluated with Kaplan-Meier analysis. Multivariable logistic regression was used to identify risk factors for stroke. RESULTS: Of 28,564 patients (median age = 60, 60% male), 653 (2.3%) experienced an acute in-hospital stroke after LTx. Median follow-up was 1.2 (stroke) and 3.0 years (non-stroke). Annual incidence of stroke increased (1.5% in 2005 to 2.4% in 2020, p-trend = 0.007), as did lung allocation score (LAS) and utilization of post-LTx extracorporeal membrane oxygenation (postLTX-ECMO) (p = 0.01 and p < 0.001, respectively). Those with stroke had lower survival at 1-month (84% vs 98%) and 12-months (61% vs 88%) compared to those without (p < 0.001; Figure). In Cox analysis, stroke had the highest hazard of death (HR = 3.05, 95% CI = 2.70-3.44). PostLTx-ECMO was the strongest risk factor of stroke (adjusted odds ratio = 2.76, 95% CI = 2.07-3.68).FigureCONCLUSION: Strokes after LTx have increased over time; this likely corresponds to the transplantation of patients with increasingly higher LAS. Strokes were associated with significant short- and long-term mortality in patients after LTx and postLTx-ECMO was a strong risk factor.