Introduction: Lung transplantation (LT) is a treatment option for end-stage chronic obstructive pulmonary disease (COPD) patients. However, the outcomes between unilateral and bilateral LT in this population remain unclear. This study aimed to compare in-hospital complications and resource utilization between unilateral and bilateral LT in COPD patients. Also, risk factors for death during hospitalization were also investigated.
Methods: The Nationwide Inpatient Sample was used to identify patients undergoing lung transplant from 2005 to 2014. Demographic characteristics, comorbidities, in-hospital complications, length of stay (LOS), and resource utilization metrics were compared between the two groups. Multivariable logistic regression analysis controlling demographics, and comorbidities, was performed to compare the cohorts of unilateral- and bilateral-LT patients.
Results: A total of 456 COPD patients underwent unilateral LT, while 721 underwent bilateral LT. Patients undergoing bilateral LT were admitted at an earlier age and had higher household income levels. They also exhibited a higher prevalence of comorbidities such as coagulopathy, liver disease, and pulmonary circulation disorders. Bilateral LT was associated with significantly higher total hospitalization costs and longer LOS. There was no difference in the risk of death during hospitalization between unilateral and bilateral LT. Older age at admission [1.07 (1.01-1.13, p=0.030)], coagulopathy [2.11 (1.02-4.37, p=0.043)], AKI during hospitalization [2.39 (1.16-4.93, p=0.018)], and sepsis during hospitalization [16.52 (7.34-37.21, p<0.001)] were independent risk factors associated with death during hospitalization.
Conclusions: In COPD patients, bilateral LT is associated with higher resource utilization compared to unilateral LT. However, both approaches have similar mortality outcomes. These findings underscore the importance of careful patient selection and post-operative management in optimizing outcomes for COPD patients undergoing LT.