ABSTRACT
SESSION TITLE: Lung Transplantation: New Issues in 2022 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: This population-based study describes the changing demographic trends of Lung Transplants (LT) across the United States (U.S.) over the last two decades (2001 vs 2021). METHODS: We utilized the Organ Procurement and Transplantation Network (OPTN) registry to gather data on LT recipients across the U.S. for the year 2001 and 2021. Total yearly lung transplant numbers were recorded from 1988 to 2021. The recipients were categorized into subgroups based on age (<1, 1-5, 6-10, 11-17, 18-49, 50-64 and >65 years), race (Whites, Blacks, Hispanic/Latino, Asians, and Others) and most common diagnosis, and data was tabulated to compare for the years 2001 and 2021. RESULTS: From 1988 to 2021, 46,109 LTs were performed in the U.S. The yearly LT recipients increased from 1,059 in 2001 to 2,524 in 2021. The most common reason for LT was Emphysema/COPD (Chronic Obstructive Pulmonary Disease) in 2001 (n=464) and IPF (Idiopathic Pulmonary Fibrosis) in 2021 (n=899). In both 2001 and 2021, most LT recipients were in the age group 50-64 years (45.8% vs 58.1%) but the proportion of patients > 65 years receiving LT increased noticeably from 3.4% in 2001 to 36.9% 2021. Most LT recipients in both 2001 vs 2021, had “O” blood group (~ 45%). White patients comprised the majority of those registered for and those who underwent LT in both 2001 (n=940;88.80%) and 2021 (n=1,778;70.40%), although the relative percentage reduced by 18.40%. The relative percentages for Blacks, Asians, Hispanics receiving LTs increased from 2001 to 2021 by 2%, 3.3% and 11.8% respectively. In both 2001 and 2021, the states where maximum LTs were performed included– California (10.8% vs 12.6%), Pennsylvania (9.6% vs 9.3%) and Texas (7.3% vs 10.7%) while the states with the least LTs included– Connecticut, Mississippi, Oregon. CONCLUSIONS: There has been a general uptrend in the total number of LTs year-on-year, and the likely drop in LT recipients in 2020 and 2021 was due to the COVID-19 pandemic. The most common diagnosis for transplant changed from Emphysema/COPD in 2001 to IPF in 2021. There are appreciable racial and geographical disparities in receiving LTs in the United States but there are encouraging improvements in 2021 compared to 2001. There is an increasing trend of LTs in elderly patients (> 65 years), likely due to increased supportive care and improved life expectancy. CLINICAL IMPLICATIONS: Changes in socio-demographic trends in lung transplant recipients help us understand existing disparities and access to advanced lung disease centers so that we can better address these with equitable healthcare delivery tailored to changing transplant trends. DISCLOSURES: No relevant relationships by FNU Amisha No relevant relationships by Perminder Gulani No relevant relationships by Manuel Hache Marliere No relevant relationships by paras malik No relevant relationships by Divya Reddy
ABSTRACT
Background and Aims: Initial reports on US COVID-19 showed different outcomes in different races. In this study, we use a diverse large cohort of hospitalized COVID-19 patients to determine predictors of mortality. Methods: We analyzed data from hospitalized COVID- 19 patients (n=5,852) from 8 hospitals. Demographics, comorbidities, symptoms and laboratory data were collected. Results: The cohort contained 3,662 (61.7%) African Americans (AA), 286 (5%) American Latinx (LAT), 1,407 (23.9%), European Americans (EA), and 93 (1.5%) American Asians (AS). Survivors and dead patients' mean ages were 58 and 68 for AA, 58 and 77 for EA, 44 and 61 for LAT, and 51 and 63 for AS. Mortality rates for AA, LAT, and EA were 14.8%, 7.3%, and 16.3%. Mortality increased among patients with the following characteristics: age, male gender, New York region, cardiac disease, COPD, diabetes mellitus, hypertension, history of cancer, immunosuppression, elevated lymphocytes, CRP, ferritin, D-Dimer, creatinine, troponin, and procalcitonin. Use of mechanical ventilation, respiratory failure, shortness of breath (SOB) (p<0.01), fatigue (p=0.04), diarrhea (p=0.02), and increased AST (p<0.01), significantly correlated with death in multivariate analysis. Male sex and EA and AA race/ethnicity had a higher frequency of death. Diarrhea was among the most common GI symptom amongst AAs (6.8%). When adjusting for comorbidities, significant variables were age (over 45 years old), male sex, EA, patients hospitalized in Indiana, Michigan, Georgia, and District of Columbia. When adjusting for disease severity, significant variables were age over 65 years old, male sex, EA as well as having SOB, elevated CRP, and D-dimer. Glucocorticoid usage was associated with an increased risk of COVID- 19 death in our cohort. Conclusion: Among this large cohort of hospitalized COVID-19 patients enriched for African Americans, predictors of mortality include male gender, diarrhea, elevated AST, comorbidities, respiratory symptoms and failure, and elevation of inflammatory- related biomarkers. These findings may reflect the extent of systemic organ involvement by SARS-CoV-2 and subsequent progression to multi-system organ failure. High mortality in AA in comparison with LAT is likely related to a high frequency of comorbidities and older age among AA.
ABSTRACT
RATIONALE: Preliminary studies have shown varied outcomes when comparing Acute Respiratory Distress Syndrome (ARDS) caused by Coronavirus Disease 2019 (COVID-19) versus “Classic” ARDS. The aim of this study was to compare patient characteristics and outcome of ARDS before and during COVID-19 pandemic. METHODS: We conducted a single center retrospective cohort study at 3 hospitals sites of Montefiore Medical Center comparing a pre-COVID respiratory failure cohort from 2017 to 2018 and a COVID respiratory failure cohort from March 2020 to May 2020. ARDS was identified by having PaO2/FiO2 ratio <= 300 and independent x-ray review consistent of bilateral infiltrates according to 2012 Berlin definition. We used Mann-Whitney-U test for non-parametric comparison of continuous variables and chi-square test for categorical variables. P < 0.05 is considered statistically significant. RESULTS: We included 1328 ARDS pre-COVID patients from 2017-2018 and 536 COVID-19 patients. The age or race was not different between the 2 ARDS cohorts (Table 1). There were more males in the COVID-19 ARDS (56.2% pre-COVID vs 61.4% COVID-19;p = 0.039). The median PaO2/FiO2 ratio for pre-COVID ARDS was higher than COVID (184 (IQR 117, 242) vs 116 (IQR 80.3, 178), p < 0.0005) with less severe ARDS in pre-COVID (18.3% vs 38.2%;p < 0.0005). In-hospital mortality almost doubled in COVID-19 ARDS (68.8%) compare with pre-COVID ARDS (37.2%, p <0.0005). The hospital length of stay was significantly longer in pre-COVID ARDS;ICU length of stay and duration of mechanical ventilation did not differ between the two ARDS groups (Table 1). CONCLUSIONS: COVID-19 ARDS presented more severely than pre-COVID ARDS based on PaO2/FiO2 ratio. The increase in in-hospital mortality in COVID-19 ARDS is likely related to the severity of respiratory failure. We need to adjust for the confounders between ARDS types and patient outcomes.