ArticleThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation2023
Transplanting candidates with stacked risks negatively affects outcomes.
Article in The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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Who cites it
4 citing papers in PubMed.
- Long-term outcomes of lung transplantation in the elderly: an analysis using the UNOS database.Journal of thoracic disease · 2026Article
- Lung transplantation for interstitial lung disease.Breathe (Sheffield, England) · 2025Review
- ERS Congress 2024: highlights from the Thoracic Surgery and Lung Transplantation Assembly.ERJ open research · 2025Article
- Donor and recipient risk factors for the development of primary graft dysfunction following lung transplantation.Frontiers in immunology · 2024Review
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Authors and funding
13 authors.
Funding
Abstract
backgroundLung transplant (LT) centers are increasingly evaluating patients with multiple risk factors for adverse outcomes. The effects of these stacked risks remains unclear. Our aim was to determine the relationship between the number of comorbidities and post-transplant outcomes.
methodsWe performed a retrospective cohort study using the National Inpatient Sample (NIS) and UNOS Starfile (USF). We applied a probabilistic matching algorithm using 7 variables (transplant: month, year, and type; recipient: age, sex, race, payer). We matched recipients in the USF to transplant patients in the NIS between 2016 and 2019. The Elixhauser methodology was used to identify comorbidities present on admission. We determined the associations between mortality, length of stay (LOS), total charges, and disposition with comorbidity numbers using penalized cubic splines, Kaplan-Meier, and linear and logistic regression methods.
resultsFrom 28,484,087 NIS admissions, we identified 1,821 LT recipients. Matches were exact in 76.8% of the cohort. While the remaining cohort had a probability match of ≥0.94. Penalized splines of Elixhauser comorbidity number identified 3 knots defining 3 groups of stacked risk: low (<3), medium (3-6), and high risk (>6). Inpatient mortality increased from low to medium to high-risk categories: (1.6%, 3.9%, and 7.0%; p < 0.001), as did LOS (16, 21, 29 days, p < 0.001), total charges ($553,057, $666,791, $821,641.5; p = 0.004) and discharge to a skilled nursing facility (15%, 20%, 31%; p < 0.001).
conclusionsStacked risks adversely affect post-LT mortality, LOS, charges, and discharge disposition. Further study to understand the details of specific stacked risks is warranted.
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