Improved survival after lung transplantation for adults requiring preoperative invasive mechanical ventilation: A national cohort study

Early survival after lung transplantation has improved in the last decade. Mechanically ventilated recipients are known to be at greater risk for early post-transplant mortality. We hypothesized that post-transplant survival in mechanically ventilated recipients has improved over time. Using a national registry, we compared hazard of death at 30 days, 4 and 14 months, 3 and 5 years, and overall for adults on mechanical ventilation who underwent lung or heart–lung transplantation from May 4, 2011, to April 4, 2018 (modern group) with those undergoing transplantation from May 4, 2005, to May 3, 2011 (early group). We quantified the impact of mechanical ventilation on survival using population-attributable fractions. We also compared mechanically ventilated recipients with nonmechanically ventilated recipients. Mechanically ventilated recipients from the modern group had lower hazard of death than recipients in the early group at all time-points, lowest at 30-days post-transplant (hazard ratio, 0.04; 95% confidence interval, 0.02-0.08). In the modern period, mechanically ventilated recipients had greater hazard of death than nonmechanically ventilated recipients at 30 days' post-transplant (9.53; 4.57-19.86). For mechanically ventilated recipients, the population attributable fraction was lower in the modern group compared to the earlier group (0.6% vs 5.7%). While mechanically ventilated recipients remain at high risk, survival in this patient population has improved over time. This may reflect improvements in perioperative recipient management. Using a national registry, we compared hazard of death for propensity score matched mechanically ventilated recipients who underwent lung transplantation from May 4, 2005, to May 3, 2011 (early group) with May 4, 2011, to April 4, 2018 (modern group), and found improved survival in the modern group compared to the early group at multiple time-points post-transplant. We quantified the impact of mechanical ventilation on survival using population attributable fractions and found a reduction in the late compared to the early group. This improvement in recipient survival may reflect improvements in recipient perioperative management over time. [Display omitted]