National Trends, Risk Factors, and Outcomes of Acute In-hospital Stroke After Lung Transplantation in the United States: Analysis of the United Network for Organ Sharing Registry

Chest. 2023 Apr 11:S0012-3692(23)00503-2. doi: 10.1016/j.chest.2023.04.007. Online ahead of print.ABSTRACTBACKGROUND: Lung transplantation is the definitive treatment for end-stage lung failure. However, there have been no large, long-term studies on the impact of acute in-hospital stroke in this population.RESEARCH QUESTION: What are the trends, risk factors, and outcomes of acute stroke in patients undergoing lung transplantation in the United States?STUDY DESIGN AND METHODS: We identified adult first-time, isolated lung transplant (LTx) recipients from the United Network for Organ Sharing (UNOS) database, which comprehensively captures every transplant in the United States, between 5/2005 and 12/2020. Stroke was defined as occurring at any time after LTx but prior to discharge. Multivariable logistic regression with stepwise feature elimination was used to identify risk factors for stroke. Freedom from death in stroke vs. non-stroke patients was evaluated with Kaplan-Meier analysis. Cox proportional hazards analysis was used to identify predictors of death at 24 months.RESULTS: Of 28,564 patients (median age=60, 60% male), 653 (2.3%) experienced an acute in-hospital stroke after LTx. Median follow-up was 1.2 (stroke) and 3.0 years (non-stroke). Annual incidence of stroke increased (1.5% in 2005 to 2.4% in 2020, p-trend=0.007), as did lung allocation score (LAS) and utilization of post-LTx extracorporeal membrane oxygenation (postLTX-ECMO) (p=0.01 and p<0.001, respective...
Source: Chest - Category: Respiratory Medicine Authors: Source Type: research