The Primary Indication for Lung Transplantation Is a Marker of Resource Utilization

We hypothesized that the primary indication for lung transplantation (LT) serves as a marker for resource utilization, reflecting differences in pathophysiology, complication risk, and perioperative management.

We analyzed adult LT recipients in the National Inpatient Sample (2005-2020) categorized by primary pulmonary diagnoses: obstructive (COPD), restrictive (IPF), cystic fibrosis (CF), and pulmonary vascular (IPAH). Length of stay (LOS) and inflation-adjusted hospitalization costs were compared across groups. Multivariable generalized linear regression assessed the association between pulmonary diagnosis group and LOS.

Among 27,422 LT recipients, 15,801 (57%) had IPF, 7604 (28%) had COPD, 2916 (11%) had CF, and 1101 (4%) had IPAH. CF (median age 32) and IPAH (50) recipients were younger than those with COPD (60) or IPF (62; P < 0.001) and differed significantly in other demographics. Median unadjusted LOS was longest for IPAH recipients (22 d; interquartile range, 12-53), followed by CF (20, 14-34), IPF (18, 12-35), and shortest for COPD (16, 11-25; P < 0.001). Unadjusted costs were highest for IPF recipients ($157,228 [$113,127-$246,215]), followed by IPAH ($151,999 [$111,725-$250,715]), CF ($149,402 [$105,379-$235,381]), and COPD ($138,116 [$105,244-$201,091]; P < 0.001). After adjustment, IPAH recipients had hospital stays 8.4 d longer than IPF (95% confidence interval, 1.75-15.11; P = 0.01), whereas COPD recipients had stays 1.8 d shorter (95% confidence interval, -3.5 to -0.04; P = 0.044).

Among lung transplant recipients, IPAH and CF are associated with the longest hospitalizations, whereas IPF is associated with the highest inpatient costs. The primary indication for LT may therefore represent an important marker of resource utilization.