In‐hospital and subsequent mortality among lung transplant recipients with a prolonged initial hospitalization. Issue 2 (23rd July 2018)

• Record Type: Journal Article
• Authors: Courtwright, Andrew M.; Rubin, Emily; Robinson, Ellen M.; Thomasson, Arwin; El‐Chemaly, Souheil; Diamond, Joshua M.; Goldberg, Hilary J.
• Is Part Of: American journal of transplantation. Volume 19:Issue 2(2019)
• Page Start: 532
• Page End: 539
• Publication Date: 2018-07-23
• Subjects: clinical research/practice -- critical care/intensive care management -- ethics -- graft survival -- hospital discharge -- lung transplantation/pulmonology; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.14982
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : The care of lung transplant recipients with prolonged index hospitalizations can be ethically complex, with conflicts arising over whether the expected outcomes justify ongoing intensive interventions. There are limited data to guide these conversations. The objective of this study was to evaluate survival to discharge for lung transplant recipients based on length of stay (LOS). This was a retrospective cohort study of adult lung transplant recipients in the Scientific Registry of Transplant Recipients. For each day of the index hospitalization the mortality rate among patients who survived to that length of stay or longer was calculated. Post‐discharge survival was compared in those with and without a prolonged hospitalization (defined as the 97th percentile [>90 days]). Among the 19 250 included recipients, the index hospitalization mortality was 5.4%. Posttransplant stroke and need for dialysis were the strongest predictors of index hospitalization mortality. No individual or combination of available risk factors, however, was associated with inpatient mortality consistently above 50%. Recipients with >90 day index hospitalization had a 28.8% subsequent inpatient mortality. Their 1, 3 and 5 year survival following discharge was 53%, 26%, and 16%. These data provide additional context to goals of care conversations for transplant recipients with prolonged index hospitalizations. Abstract : Data from the Scientific Registry of Transplant Recipients demonstrates that although increased length of initial hospital stay is associated with decreased survival following lung transplant, in‐hospital mortality rarely exceeds 50%, even for patients with significant complications and prolonged hospitalization.