Time on the waiting list is an independent risk factor for day-90 mortality after lung transplantation

Abstract

Background

The waitlist deaths of transplantation candidates based on their time on the waiting list (TWL) have already been studied, but the short-term mortality and early complications of lung transplant (LT) recipients based on their TWL have not been specifically studied. The first aim of this study was to assess the relationship between increased TWL and short-term mortality in LT recipients.

Methods

In this observational, monocentric, retrospective study, all patients who underwent LT between January 2016 and August 2022 at Bichat Claude Bernard Hospital, Paris were analyzed. Univariate analysis (chi2 test, Mann–Whitney test, Fisher’s exact test) and multivariate analysis (logistic regression) were performed. Ninety-days and one-year survival were studied (Kaplan–Meier curves, log-rank test). p < 0.05 indicated statistical significance.

Results

242 LT patients were analyzed. The median TWL was 100 (43−229) days. Postoperative complications, including septic shock (36 versus 18%, p = 0.002), grade 3 primary graft dysfunction (31 versus 20%, p < 0.001), and KDIGO3 acute kidney injury (8 versus 25%, p < 0.001), were more common in the prolonged TWL (pTWL) group (>100 days) than in the short TWL group (≤100 days). The duration of hospitalization in the ICU was longer (18 [11−34] versus 13 [9−23] days, p = 0.02) in the pTWL group. According to our multivariate analysis, TWL was an independent risk factor for 90-days mortality (OR 1.02, 95% CI [1.00−1.04]; p = 0.032).

Conclusion

TWL was an independent risk factor for 90-days mortality after LT. Receiving LT after more than 100 days on the waitlist exposes to increased postoperative complications.