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)

Figures & data

Table 1 Incidence, sociodemographic and clinical characteristics of patients hospitalized who underwent a lung transplantation in Spain from 2001 to 2015 according to COPD status

	2001–2003		2004–2006		2007–2009		2010–2012		2013–2015		Total
	COPD	No COPD	COPD	No COPD	COPD	No COPD	COPD	No COPD	COPD	No COPD	COPD	No COPD
Number of transplantations	162	262	180	264	205	358	271	374	324	496	1,142	1,754
Incidence per 100,000*,†,a–f	3.25	0.26	2.88	0.25	2.52	0.33	3.25	0.34	6.48	0.43	3.49	0.33
Type
Aspecific*,†,f	3.7	3.82	3.33	2.65	0.49	3.07	2.21	1.87	0.31	1.41	1.75	2.39
Single*,†	27.78	29.77	22.22	37.5	43.41	44.97	43.17	145.99	39.81	41.73	36.78	40.88
Bilateral*,†,b	68.52	66.41	74.44	59.85	56.1	51.96	54.61	52.14	59.88	56.85	61.47	56.73
Female sex, n (%)*,†,a–f	25 (15.43)	113 (43.13)	44 (24.44)	128 (48.48)	43 (20.98)	157 (43.85)	79 (29.15)	152 (40.64)	101 (31.17)	207 (41.73)	292 (25.57)	757 (43.16)
Age, mean (SD)*,†,a–f	51.94 (9.94)	41.95 (16.97)	53.69 (8.44)	42.73 (16.42)	54.54 (9.49)	43.68 (16.68)	56.98 (7.73)	46.11 (15.5)	57.35 (7.17)	49.47 (14.61)	55.41 (8.6)	45.43 (16.11)
<40 years, n (%)†,a–f	20 (12.35)	107 (40.84)	9 (5)	113 (42.8)	14 (6.83)	135 (37.71)	8 (2.95)	108 (28.88)	12 (3.7)	120 (24.19)	63 (5.52)	583 (33.24)
40–49 years, n (%)*,†,a–f	26 (16.05)	44 (16.79)	26 (14.44)	28 (10.61)	28 (13.66)	52 (14.53)	26 (9.59)	76 (20.32)	17 (5.25)	69 (13.91)	123 (10.77)	269 (15.34)
50–59 years, n (%)*†,a–f	80 (49.38)	70 (26.72)	111 (61.67)	78 (29.55)	96 (46.83)	102 (28.49)	119 (43.91)	107 (28.61)	150 (46.3)	152 (30.65)	556 (48.69)	509 (29.02)
≥60 years, n (%)*,†,a–f	36 (22.22)	41 (15.65)	34 (18.89)	45 (17.05)	67 (32.68)	69 (19.27)	118 (43.54)	83 (22.19)	145 (44.75)	155 (31.25)	400 (35.03)	393 (22.41)
CCI, n (%)
0*,†,a–f	128 (79.01)	185 (70.61)	142 (78.89)	180 (68.18)	156 (76.1)	240 (67.04)	198 (73.06)	277 (74.06)	223 (68.83)	322 (64.92)	847 (74.17)	1,204 (68.64)
≥1*,†,a–f	34 (20.99)	77 (29.39)	38 (21.11)	84 (31.82)	49 (23.9)	118 (32.96)	73 (26.94)	97 (25.94)	101 (31.17)	174 (35.08)	295 (25.83)	550 (31.36)
LOHS, median (IQR)	30 (23)	33.5 (32)	37 (33.5)	34 (32.5)	32 (26)	38.5 (41)	38 (36)	38 (33)	33 (26)	36 (34)	34 (29)	36 (34)
IHM, n (%)*,†,f	35 (21.6)	87 (33.21)	43 (23.89)	72 (27.27)	48 (23.41)	83 (23.18)	34 (12.55)	62 (16.58)	36 (11.11)	65 (13.1)	196 (17.16)	369 (21.04)
Infection, n (%)*,†	17 (10.49)	21 (8.02)	21 (11.67)	34 (12.88)	30 (14.63)	43 (12.01)	52 (19.19)	73 (19.52)	53 (16.36)	97 (19.56)	173 (15.15)	268 (15.28)
Complications of transplanted lung or rejection, n (%)	80 (49.38)	124 (47.33)	104 (57.78)	134 (50.76)	80 (39.02)	158 (44.13)	111 (40.96)	155 (41.44)	159 (49.07)	237 (47.78)	534 (46.76)	808 (46.07)

Notes: Incidence per 100,000 inhabitants.

* P<0.05 for time trend among non-COPD patients using Poisson or logistic regression adjusted by age and sex when appropriate;

† P<0.05 for time trend among COPD patients using Poisson or logistic regression adjusted by age and sex when appropriate;

a P<0.05 for difference when comparing patients with and without COPD (2001–2003) using χ² (proportions) and Kruskal–Wallis test (median) as appropriate;

b P<0.05 for difference when comparing patients with and without COPD (2004–2006) using χ² (proportions) and Kruskal–Wallis test (median) as appropriate;

c P<0.05 for difference when comparing patients with and without COPD (2007–2009) using χ² (proportions) and Kruskal–Wallis test (median) as appropriate;

d P<0.05 for difference when comparing patients with and without COPD (2010–2012) using χ² (proportions) and Kruskal–Wallis test (median) as appropriate;

e P<0.05 for difference when comparing patients with and without COPD (2013–2015) using χ² (proportions) and Kruskal–Wallis test (median) as appropriate;

f P<0.05 for difference when comparing patients with and without COPD (total) using χ² (proportions) and Kruskal–Wallis test (median) as appropriate.

Abbreviations: CCI, Charlson Comorbidity Index; LOHS, length of hospital stay; IHM, in-hospital mortality.

Figure 1 Temporal trend in the number of single and bilateral lung transplantations according to COPD status in Spain, 2001–2015.

Table 2 Procedures conducted on hospitalized patients who underwent lung transplantation in Spain from 2001 to 2015 according to COPD status

	COPD	2001–2003	2004–2006	2007–2009	2010–2012	2013–2015	Total
Noninvasive mechanical ventilation, n (%)*,†,a,f	Yes	2 (1.23)	10 (5.56)	22 (10.73)	70 (25.83)	59 (18.21)	163 (14.27)
	No	7 (2.67)	21 (7.95)	68 (18.99)	71 (18.98)	67 (13.51)	234 (13.34)
Mechanical ventilation, n (%)*,†	Yes	83 (51.23)	100 (55.56)	92 (44.88)	141 (52.03)	125 (38.58)	541 (47.37)
	No	121 (46.18)	126 (47.73)	160 (44.69)	174 (46.52)	198 (39.92)	779 (44.41)
Thoracocentesis, n (%)*	Yes	2 (1.23)	7 (3.89)	9 (4.39)	7 (2.58)	7 (2.16)	32 (2.8)
	No	0	5 (1.89)	11 (3.07)	6 (1.6)	14 (2.82)	36 (2.05)
Pleural drainage tube insertion, n (%)*	Yes	27 (16.67)	40 (22.22)	48 (23.41)	83 (30.63)	61 (18.83)	259 (22.68)
	No	38 (14.5)	50 (18.94)	87 (24.3)	105 (28.07)	105 (21.17)	385 (21.95)
Bronchoscopy, n (%)*,†	Yes	58 (35.8)	92 (51.11)	108 (52.68)	165 (60.89)	217 (66.98)	640 (56.04)
	No	82 (31.3)	135 (51.14)	176 (49.16)	221 (59.09)	335 (67.54)	949 (54.1)
Transfusion, n (%)†	Yes	43 (26.54)	44 (24.44)	40 (19.51)	57 (21.03)	54 (16.67)	238 (20.84)
	No	57 (21.76)	55 (20.83)	86 (24.02)	87 (23.26)	92 (18.55)	377 (21.49)
Hemodialysis, n (%)	Yes	6 (3.7)	10 (5.56)	13 (6.34)	16 (5.9)	13 (4.01)	58 (5.08)
	No	19 (7.25)	10 (3.79)	20 (5.59)	26 (6.95)	32 (6.45)	107 (6.1)
Extracorporeal membrane oxygenation, n (%)*,†	Yes	0	0	1 (0.49)	7 (2.58)	17 (5.25)	25 (2.19)
	No	0	0	7 (1.96)	16 (4.28)	39 (7.86)	62 (3.53)
Tracheostomy, n (%)	Yes	35 (21.6)	45 (25)	51 (24.88)	78 (28.78)	66 (20.37)	275 (24.08)
	No	55 (20.99)	63 (23.86)	98 (27.37)	101 (27.01)	133 (26.81)	450 (25.66)

Notes:

* P<0.05 for time trend among non-COPD patients using Poisson or logistic regression adjusted by age and sex when appropriate;

† P<0.05 for time trend among COPD patients using Poisson or logistic regression adjusted by age and sex when appropriate;

a P<0.05 for difference when comparing patients with and without COPD (2007–2009) using χ² (proportions) and Kruskal–Wallis test (median) as appropriate;

b P<0.05 for difference when comparing patients with and without COPD (2010–2012) using χ² (proportions) and Kruskal–Wallis test (median) as appropriate.

Table 3 Pathogen isolates from hospitalized patients who underwent lung transplantation in Spain from 2010 to 2015 according to COPD status

	COPD	2001–2003	2004–2006	2007–2009	2010–2012	2013–2015	Total
Blood culture, n (%)*,†	Yes	0	0	1 (0.49)	12 (4.43)	52 (16.05)	65 (5.69)
	No	1 (0.38)	0	2 (0.56)	10 (2.67)	76 (15.32)	89 (5.07)
Respiratory culture, n (%)*,†,a	Yes	1 (0.62)	0	0	6 (2.21)	23 (7.1)	30 (2.63)
	No	0	2 (0.76)	0	1 (0.27)	31 (6.25)	34 (1.94)
Candidiasis, n (%)	Yes	4 (2.47)	8 (4.44)	7 (3.41)	10 (3.69)	10 (3.09)	39 (3.42)
	No	10 (3.82)	10 (3.79)	15 (4.19)	8 (2.14)	13 (2.62)	56 (3.19)
Cytomegalovirus, n (%)	Yes	4 (2.47)	2 (1.11)	7 (3.41)	5 (1.85)	8 (2.47)	26 (2.28)
	No	2 (0.76)	13 (4.92)	9 (2.51)	7 (1.87)	14 (2.82)	45 (2.57)
Other Gram-negative bacteria, n (%)	Yes	2 (1.23)	0	2 (0.98)	1 (0.37)	2 (0.62)	7 (0.61)
	No	1 (0.38)	4 (1.52)	3 (0.84)	4 (1.07)	0	12 (0.68)
Pseudomonas aeruginosa, n (%)	Yes	2 (1.23)	7 (3.89)	5 (2.44)	8 (2.95)	3 (0.93)	25 (2.19)
	No	7 (2.67)	4 (1.52)	9 (2.51)	8 (2.14)	6 (1.21)	34 (1.94)
Staphylococcus aureus*,†,a	Yes	4 (2.47)	3 (1.67)	3 (1.46)	0	1 (0.31)	11 (0.96)
	No	7 (2.67)	7 (2.65)	3 (0.84)	1 (0.27)	4 (0.81)	22 (1.25)
Streptococcus pneumoniae, n (%)*,†	Yes	2 (1.23)	1 (0.56)	1 (0.49)	0	0	4 (0.35)
	No	3 (1.15)	3 (1.14)	1 (0.28)	1 (0.27)	0	8 (0.46)
Aspergillus, n (%)	Yes	9 (5.56)	9 (5)	10 (4.88)	19 (7.01)	16 (4.94)	63 (5.52)
	No	11 (4.2)	20 (7.58)	22 (6.15)	34 (9.09)	26 (5.24)	113 (6.44)

Notes:

* P<0.05 for time trend among non-COPD patients using Poisson or logistic regression adjusted by age and sex when appropriate;

† P<0.05 for time trend among COPD patients using Poisson or logistic regression adjusted by age and sex when appropriate;

a P<0.05 for difference when comparing patients with and without COPD (2010–2012) using χ² (proportions) and Kruskal–Wallis test (median) as appropriate.

Table 4 Multivariate analysis of factors associated with mortality during hospital admission for lung transplantation in Spain, 2001–2015

	COPD		No COPD		Both
	OR (95% CI)	P-value	OR (95% CI)	P-value	OR (95% CI)	P-value
Sex
Male	1		1		1
Female	1.13 (0.77–1.67)	0.524	1.04 (0.82–1.33)	0.748	1.06 (0.87–1.31)	0.552
Age-group
<40 years	1		1		1
40–49 years	1.57 (0.63–3.92)	0.337	1.16 (0.8–1.69)	0.429	1.16 (0.83–1.62)	0.375
50–59 years	1.84 (0.81–4.17)	0.143	1.41 (1.04–1.91)	0.026	1.35 (1.03–1.78)	0.030
≥60 years	2.16 (0.93–5.02)	0.073	1.18 (0.84–1.66)	0.349	1.33 (0.99–1.79)	0.059
CCI
0	1		1		1
≥1	2.5 (1.76–3.56)	<0.001	1.66 (1.3–2.13)	<0.001	1.87 (1.53–2.29)	<0.001
In-hospital infection
No	1		1		1	1
Yes	4.78 (3.24–7.04)	<0.001	2.44 (1.81–3.31)	<0.001	3.09 (2.44–3.91)	<0.001
Year	0.7 (0.62–0.79)	<0.001	0.7 (0.64–0.76)	<0.001	0.7 (0.66–0.76)	<0.001
COPD
No	NA		NA		1
Yes	NA		NA	<0.001	0.75 (0.61–0.93)	0.009

Abbreviation: CCI, Charlson Comorbidity Index.