Trends and hospital outcomes of lung transplantation among patients with and without chronic obstructive pulmonary disease in Spain: a national population-based study (2001–2015)

Abstract

Purpose

To describe trends from 2001 to 2015 in incidence and in-hospital outcomes of patients suffering or not suffering from COPD who had undergone lung transplantation (LTx) in Spain.

Methods

We used the Spanish National Hospital Discharge Database to select all admissions for LTx. Incidence was estimated overall and according to the presence of COPD. Outcomes included infections, complications, length of hospital stay and in-hospital mortality (IHM).

Results

We identified 2,896 admissions for LTx. Admission rates rose in COPD sufferers and non-COPD sufferers over time, with higher rates among COPD patients. COPD and non-COPD patients were older, but mean age was higher in COPD patients. Although there was a male predominance among patients, the proportion of women significantly increased over time in the COPD population. COPD patients had lower Charlson Comorbidity Index values than non-COPD patients (score ≥1, 25.83% and 31.6%, P<0.05). We observed a significant increase in infections and complications of LTx or rejection for both groups over time. IHM decreased from 2001 to 2015 in both groups of patients. COPD was a predictor of lower IHM (OR 0.75, 95% CI 0.61–0.93) after LTx.

Conclusion

LTx-incidence rates were higher in COPD patients and increased over the study period in both groups. The proportion of women significantly increased over time among COPD sufferers. IHM decreased from 2001 to 2015 in both groups of patients. COPD was a predictor of lower mortality during admissions for LTx.

Keywords:

• lung transplantation
• COPD
• hospital admissions
• incidence rates
• in-hospital mortality
• Spain

Acknowledgments

This paper was funded by the Fondo de Investigaciones Sanitarias (FIS) – Instituto de Salud Carlos III (ISCIII) and cofinanced by the European Union through the Fondo Europeo de Desarrollo Regional (FEDER, “Una manera de hacer Europa”): grant PI16/00564. The authors would like to thank NeumoMadrid (XVIII Awards Edition, 2018) for grant support.

Disclosure

The authors report no conflicts of interest in this work.