Increasing risk of postlung transplant hospitalizations for infection: An analysis of recent trends

JHLT Open Pub Date : 2025-02-26 DOI:10.1016/j.jhlto.2025.100231

Shi Nan Feng BSPH , Armaan F. Akbar BS , Alice L. Zhou MS , Andrew Kalra BS , Sean Agbor-Enoh MD, PhD , Christian A. Merlo MD, MPH , Errol L. Bush MD

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引用次数: 0

Abstract

Background

Despite advancements in lung transplantation (LT), infection remains a major cause of morbidity and mortality following LT. We examined trends in hospitalizations for infection in the first year after LT.

Methods

We identified adult LT recipients in the United States (March 1, 2018-March 9, 2023) using the Organ Procurement and Transplantation Network database. We categorized transplants into 3 eras to account for the Composite Allocation Score allocation policy change and coronavirus disease 2019: March 2018 to March 2020, March 2020 to March 2022, and March 2022 to March 9, 2023. One-year post-LT survival was compared using Kaplan-Meier survival analysis and Cox proportional hazards regression. Hospitalizations for infection were compared using multivariable logistic regression, adjusted for era and donor and recipient characteristics.

Results

Of 12,388 LT recipients (median age = 62, male = 61.2%), hospitalization for infection in the first-year post transplant was 5.2% for patients transplanted from March 2018 to March 2020 (N = 5,031), 7.6% from March 2020 to March 2022 (N = 4,659), and 13.2% post-March 2022 (N = 3,640) (p < 0.001). Compared to March 2018 to March 2020, patients transplanted from March 2020 to March 2022 (adjusted aoods ratio [aOR] = 1.50, 95% confidence interval [CI] = 1.26-1.79) and post-March 2022 (aOR = 2.89, 95% CI = 2.29-3.65) were more likely to be hospitalized for an infection. After adjustment, we found no significant difference in risk of death following LT for recipients transplanted between March 2020 and March 2022 (aHR = 1.09, 95% CI = 0.96-1.23, p = 0.175) compared to March 2018 and March 2020. Post-March 2022 risk of death was elevated (aHR = 1.21, 95% CI = 1.04, 1.40, p = 0.014).

Conclusions

Odds of hospitalization for infection in the first year after LT performed between March 2020 and March 2022 and post-March 2022 were 1.50 and 2.89 times as high, respectively, as LT performed between March 2018 and March 2020.

IRB NUMBERS

IRB00352819

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肺移植后感染住院风险增加：近期趋势分析

尽管在肺移植（LT）方面取得了进展，但感染仍然是LT后发病和死亡的主要原因。我们研究了LT后第一年因感染住院的趋势。方法我们使用器官获取和移植网络数据库确定了美国成年LT受体（2018年3月1日至2023年3月9日）。我们将移植分为三个时期，以考虑综合分配评分分配政策变化和2019年冠状病毒病：2018年3月至2020年3月，2020年3月至2022年3月，以及2022年3月至2023年3月9日。采用Kaplan-Meier生存分析和Cox比例风险回归比较术后1年生存率。采用多变量logistic回归对感染住院率进行比较，并根据年龄和供体和受体特征进行调整。结果12,388例移植患者（中位年龄= 62岁，男性= 61.2%）中，2018年3月至2020年3月移植的患者（N = 5,031）， 2020年3月至2022年3月移植的患者（N = 4,659），移植后第一年因感染住院的比例为5.2%，2022年3月移植的患者（N = 3,640）的住院率为7.6% (p <；0.001)。与2018年3月至2020年3月相比，2020年3月至2022年3月移植的患者（调整后aOR比[aOR] = 1.50, 95%可信区间[CI] = 1.26-1.79）和2022年3月后移植的患者（aOR = 2.89, 95% CI = 2.29-3.65）因感染住院的可能性更高。调整后，我们发现与2018年3月和2020年3月相比，2020年3月和2022年3月之间移植受体的肝移植后死亡风险无显著差异（aHR = 1.09, 95% CI = 0.96-1.23, p = 0.175）。2022年3月后死亡风险升高（aHR = 1.21, 95% CI = 1.04, 1.40, p = 0.014）。结论2020年3月~ 2022年3月行肝移植术后1年及术后感染住院率分别是2018年3月~ 2020年3月行肝移植的1.50倍和2.89倍。IRB NUMBERSIRB00352819

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JHLT Open

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