Days Alive and Out of Hospital Around Lung Transplantation: Predictors and Clinical Implications

Days alive and out of hospital (DAOH) is a validated patient-centered outcome that remains unexplored in lung transplantation (LT). It assesses the proportion of days a patient spends alive and outside of hospital. Quantifying DAOH trajectories around LT could provide patients with realistic expectations and could prepare them better for the demanding posttransplant period.

What are the estimates of DAOH before and after LT?

DAOH in the year before transplantation (DAOH-BF), DAOH in the first year after first LT (DAOH-AF1), and DAOH in the second year after first LT (DAOH-AF2) were calculated for all patients who underwent transplantation in France between 2020 and 2023. Clinical variables were collected to identify predictors of DAOH-AF1 using a 2-part model.

One thousand two hundred twenty-two patients were included (56% male; median age, 57 years [interquartile range (IQR), 47-62 years). Median DAOH-BF was 95% (IQR, 89%-99%), whereas median DAOH-AF1 declined to 80% (IQR, 64%-87%; P < .001). Among patients discharged after the transplantation-related hospital stay, connective tissue disease (β = -4.1; P = .05) and single LT (β = -4.0; P = .040) were associated independently with lower DAOH-AF1. Median DAOH-AF2 subsequently recovered to 98.6% (IQR, 95.1%-100%).

Our results show that DAOH is reduced significantly during the first year after LT, particularly among patients with connective tissue disease and in case of single LT. These findings have direct implications for counselling before LT, informing patients about the demanding nature of the first year after LT while offering reassurance that DAOH improves substantially beyond this period. Identified predictors of lower DAOH-AF1 allow clinicians to tailor information provided before LT further to high-risk subgroups.