One-Year Mortality After Lung Transplantation: Experience of a Single French Center Between 2012 and 2021

Thi Cam Tu Hoang; Lien Han; Sandrine Hirschi; Tristan Degot; Justine Leroux; Pierre-Emmanuel Falcoz; Anne Olland; Nicola Santelmo; Marion Villard; Olivier Collange; Gauthier Appere; Romain Kessler; Benjamin Renaud-Picard

doi:10.12659/AOT.944420

20 August 2024 : Original article

One-Year Mortality After Lung Transplantation: Experience of a Single French Center Between 2012 and 2021

Thi Cam Tu Hoang^1ABCDEF, Lien Han^2CDE, Sandrine Hirschi^1ADEF, Tristan Degot^1ADEF, Justine Leroux^1ADEF, Pierre-Emmanuel Falcoz

^3ADEF, Anne Olland^34ADEF, Nicola Santelmo^3ADEF, Marion Villard^3BF, Olivier Collange^5ADEF, Gauthier Appere^5ADEF, Romain Kessler^14ADEF, Benjamin Renaud-Picard

^14ACDEF*

DOI: 10.12659/AOT.944420

Ann Transplant 2024; 29:e944420

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Table 2 Characteristics of patients who survived and those who died during the first year after lung transplantation between 2012 and 2021.

Characteristics	Missing data (n, %)		Survivorsn=376	Non-survivorsn=49	OR	p-value
Age at transplant (years old)	0 (0)	Median [IQR]	57 [47;62]	60 [53;62]	1.01 (0.99–1.04)	0.443
			228 (60.6)	22 (44.9)	ref
		60–65 (n, %)	109 (29.0)	20 (40.8)	1.90 (0.99–3.64)	0.052
		>65 (n, %)	39 (10.4)	7 (14.3)	1.86 (0.7–4.46)	0.184
Gender	0 (0)	Male (n, %)	204 (54.3)	31 (63.3)	1.45 (0.79–2.73)	0.235
BMI (kg/m)	12 (2.8)	Median [IQR]	22 [19; 26]	23 [19; 28]	1.05 (0.99–1.12)	0.094
		18.5–25 (n, %)	189 (51.5)	17 (37.0)	ref
			77 (21.0)	9 (19.6)	1.30 (0.53–2.98)	0.546
		25–30 (n, %)	74 (20.2)	16 (34.8)	2.40 (1.15–5.03)	0.019
		>30 (n, %)	27 (7.3)	4 (8.6)	1.65 (0.45–4.86)	0.400
Waiting time from listing to transplantation (months)	0 (0)	Median [IQR]	4 [1; 7]	3 [0; 8]	1.00 (0.93–1.05)	0.888
			92 (24.5)	13 (26.5)	ref
		1–6 (n, %)	178 (47.3)	23 (46.9)	0.91 (0.45–1.94)	0.809
		6–12 (n, %)	75 (19.9)	11 (22.4)	1.04 (0.43–2.45)	0.932
		>12 (n, %)	31 (8.3)	2 (4.2)	0.46 (0.07–1.78)	0.319
Organ transplanted	0 (0)	Lung (n, %)	356 (94.7)	46 (93.9)	ref
		Heart-Lung (n, %)	14 (3.7)	3 (6.1)	1.66 (0.37–5.32)	0.440
		Pancreatic islet-lung (n, %)	6 (1.6)	0 (0)	Indeterminate	0.988
Native lung disease	0 (0)	COPD or A1ATd (n, %)	196 (52.1)	21 (42.9)	ref
		ILD (n, %)	71 (18.9)	13 (26.5)	1.71 (0.80–3.56)	0.158
		CF (n, %)	46 (12.2)	8 (16.3)	1.62 (0.64–3.77)	0.278
		PAH (n, %)	19 (5.1)	4 (8.2)	1.96 (0.53–5.84)	0.257
		Re-transplantation (n, %)	11 (2.9)	2 (4.1)	1.70 (0.25–6.89)	0.510
		Others (n, %)	33 (8.8)	1 (2.0)	0.28 (0.02–1.43)	0.225
Transplant type	0 (0)	Unilateral (n, %)	12 (3.2)	3 (6.1)	1.98 (0.44–6.51)	0.304
Super-urgent transplantation	0 (0)		60 (16.0)	9 (18.4)	1.18 (0.52–2.47)	0.667
Medical condition at transplantation	0 (0)	Not hospitalized (n, %)	291 (77.4)	34 (72.3)	ref
		Hospitalized but not in ICU (n, %)	43 (11.4)	6 (12.8)	1.19 (0.43–2.83)	0.707
		Hospitalized in ICU (n, %)	42 (11.2)	7 (14.9)	1.43 (0.55–3.26)	0.426
Preoperative invasive ventilation support	1 (0.2)	n, %	27 (7.2)	5 (10.4)	1.50 (0.49–3.81)	0.427
Preoperative ECMO support	1 (0.2)	n, %	18 (4.8)	4 (8.3)	1.81 (0.51–5.11)	0.303
Comorbidities
Systemic hypertension	0 (0)	n, %	105 (27.9)	18 (36.7)	1.50 (0.49–3.81)	0.203
Heart failure	0 (0)	n, %	14 (3.7)	4 (8.2)	2.30 (0.63–6.73)	0.157
Coronary artery disease	0 (0)	n, %	57 (15.2)	13 (26.5)	2.02 (0.98–3.96)	0.047
Cerebrovascular disease	0 (0)	n, %	14 (3.7)	1 (2.0)	0.54 (0.03–2.77)	0.554
Diabetes mellitus	0 (0)	n, %	102 (27.1)	19 (38.8)	1.70 (0.90–3.13)	0.091
Gastroesopha-geal reflux/ esophageal dysfunction/ gastric ulcer	0 (0)	n, %	78 (20.7)	14 (28.6)	1.53 (0.76–2.93)	0.213
Liver disease	0 (0)	n, %	32 (8.5)	4 (8.2)	0.96 (0.28–2.55)	0.935
Psychiatric disorder	0 (0)	n, %	62 (16.5)	8 (16.3)	0.99 (0.41–2.11)	0.977
Smoking status – ever smoker	15 (3.5)	n, %	285 (78.5)	36 (76.6)	0.9 (0.45–1.92)	0.764
Geographical location (km)	2 (0.5)		106 (28.2)	19 (40.4)	ref
		100–200 (n, %)	185 (49.2)	21 (44.7)	0.63 (0.33–1.24)	0.178
		>200 (n, %)	85 (22.6)	7 (14.9)	0.46 (0.17–1.92)	0.095
Blood type	0 (0)	O (n, %)	147 (39.1)	21 (42.9)	ref
		A (n, %)	186 (49.5)	22 (44.9)	0.83 (0.44–1.57)	0.561
		B (n, %)	24 (6.4)	4 (8.2)	1.17 (0.32–3.40)	0.793
		AB (n, %)	19 (5.0)	2 (4.0)	0.74 (0.11–2.80)	0.695
CMV mismatch (D+/R−)	16 (3.8)	n, %	75 (20.2)	5 (13.2)	0.60 (0.20–1.46)	0.301
Laboratory values before transplantation
GFR (mL/min/ 1.73 m)	4 (0.9)	Median [IQR]	90 [90;104]	90 [78;90]	0.98 (0.96–1.00)	0.017
FVC (%)	49 (11.5)	Median [IQR]	52 [42;64]	48 [40;62]	0.99 (0.97–1.01)	0.281
FEV1 (%)	15 (3.5)	Median [IQR]	22 [17;31]	22 [18;36]	1.01 (0.99–1.02)	0.505
mPAP	96 (22.6)	Median [IQR]	25 [20;32]	25 [18;34]	1.00 (0.96–1.03)	0.828
Ischemic time (min)	38 (8.9)	Median [IQR]	375 [336;420]	409 [361;439]	1.003 (1.001–1.01)	0.040
Intraoperative ECC	9 (2.1)	n, %	85 (23.0)	25 (54.3)	3.99 (2.13–7.55)
Postoperative ECMO support	1 (0.2)	n, %	8 (2.1)	8 (16.7)	9.20 (3.22–26.32)
Invasive ventilation time after transplantation (days)	74 (17.4)	Median [IQR]	1 [1; 2]	3 [1; 10]	1.18 (1.09–1.27)
Postoperative tracheotomy	1 (0.2)	n, %	55 (14.6)	16 (33.3)	2.92 (1.47–5.61)	0.002
ICU stay length after transplantation (days)	1 (0.2)	Median [IQR]	7 [5;12]	14 [6;45]	1.05 (1.03–1.06)
Hospital stay length after transplantation (days)	1 (0.2)	Median [IQR]	36 [33;44]	44 [15;80]	1.01 (1.00–1.02)	0.016
Induction immunosuppression	55 (12.9)	Basiliximab (n, %)	327 (96.7)	27 (84.4)	ref
		Thymoglobulin (n, %)	4 (1.2)	1 (3.1)	3.03 (0.15–21.38)	0.330
		No (n, %)	7 (2.1)	4 (12.5)	6.92 (1.73–24.45)	0.003
Maintenance immunosuppression
Azathioprine	3 (0.7)	n, %	26 (6.9)	1 (2.2)	0.30 (0.02–1.46)	0.242
Cellcept	3 (0.7)	n, %	323 (85.9)	36 (78.3)	0.59 (0.29–1.32)	0.174
Cyclosporine	3 (0.7)	n, %	14 (3.7)	2 (4.3)	1.18 (0.18–4.39)	0.834
Everolimus	3 (0.7)	n, %	17 (4.5)	3 (6.5)	1.47 (0.33–4.61)	0.549
Myfortic	3 (0.7)	n, %	15 (4.0)	0 (0)	Indeterminate	0.988
Tacrolimus	3 (0.7)	n, %	355 (94.4)	35 (76.1)	0.19 (0.09–0.43)
Post-transplant DSA	2 (0.5)	n, %	55 (14.6)	3 (6.4)	0.40 (0.09–1.14)	0.134
Best value of FEV1 within the 1 year (L)	34 (8.0)	Median [IQR]	2.6 [2.1;3.1]	1.5 [1.2;2.0]	0.11 (0.04–0.27)
Best value of FEV1 within 1 year (% predicted values)	37 (8.7)	Median [IQR]	94 [77;111]	54 [40;85]	0.94 (0.91–0.96)
Best value of FEV1 within the 1 year	37 (8.7)	n, %	100 (27.0)	12 (70.6)	6.50 (2.35–20.9)
Early postoperative complications
Acute kidney injury requiring RRT	2 (0.5)	n, %	33 (8.8)	29 (61.7)	16.8 (8.50–33.91)
Cardiac arrest	2 (0.5)	n, %	20 (5.3)	19 (40.4)	12.08 (5.79–25.4)
Hemothorax	2 (0.5)	n, %	37 (9.8)	13 (27.7)	3.50 (1.66–7.11)
Infection	1 (0.2)	n, %	207 (55.1)	33 (68.8)	1.80 (0.96–3.51)	0.074
PGD grade 3	135 (31.8)	n, %	118 (45.6)	22 (71.0)	2.92 (1.33–6.91)	0.009
Stroke	1 (0.2)	n, %	16 (4.3)	6 (12.5)	3.21 (1.10–8.30)	0.021
ICU readmission	1 (0.2)	n, %	39 (10.4)	15 (31.2)	3.93 (1.92–7.78)
Other complications post lung transplant within the 1 year
Treated acute cellular rejection	1 (0.2)	n, %	66 (17.6)	10 (20.8)	1.24 (0.56–2.52)	0.577
Antibody mediated rejection	1 (0.2)	n, %	10 (2.7)	3 (6.2)	2.44 (0.53–8.33)	0.188
Airway stenosis requiring a prosthesis	1 (0.2)	n, %	14 (3.7)	0 (0)	Indeterminate	0.988
IQR – interquartile range; OR – odds ratio; BMI – body mass index; ILD – interstitial lung disease; COPD – chronic obstructive pulmonary disease; A1ATd – alpha-1 antitrypsin deficiency; CF – cystic fibrosis; PAH – pulmonary artery hypertension; ICU – Intensive Care Unit; ECMO – extracorporeal membrane oxygenation; CMV – cytomegalovirus; D – donor; R – recipient; GFR – glomerular filtration rate; FVC – forced vital capacity; FEV1 – forced expiratory volume in the first second; mPAP – mean pulmonary artery pressure; ECC – extracorporeal circulation; DSA – donor-specific anti-HLA antibodies; RRT – renal replacement therapy; PGD – primary graft dysfunction.

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One-Year Mortality After Lung Transplantation: Experience of a Single French Center Between 2012 and 2021

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