PloS one · 2025
Invasive candidiasis following lung transplant: An Assessment of impact utilizing a national insurance claims cohort.
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Pennington Kelly M, Heien Herb, Yadav Hemang, Yao Xiaoxi, White Bradley, Peters Steve G, Escalante Patricio, Ngufor Che, Razonable Raymund R, Kennedy Cassie C
Аннотация
INTRODUCTION: Lung transplant recipients (LTRs) are susceptible to invasive candidiasis (IC). This study aimed to assess the incidence, risk factors, and impact of IC on mortality in LTRs using a national insurance claims cohort.
METHODS: We conducted a retrospective cohort study using administrative claims data from the OptumLabs® Data Warehouse. We identified LTRs from January 1, 2005, to December 31, 2023, using procedural codes. Exclusion criteria included re-transplantations and pre-transplant IC. We employed multivariable logistic regression to identify risk factors for IC and Cox Proportional Hazard models to assess the impact of IC on mortality.
RESULTS: Among 1279 LTRs, 131 (10.2%) developed IC, primarily during the initial hospitalization for lung transplantation (index hospitalization). The median time to IC diagnosis was 32.0 days following transplant. Post-transplant extra-corporeal membrane oxygenation (ECMO) for more than 8 days was associated with IC (OR: 2.34; 95% CI 1.03 to 5.34). Mortality was higher in LTRs with IC (HR: 2.31; 95% CI: 1.45 to 3.67; p < 0.001). LTRs with IC also had longer hospital stays (median 26.0 days vs. 20.0 days; p < 0.001) and more re-operations (36.7% vs. 27.3%; p = 0.003) compared to those without IC.
CONCLUSION: Invasive candidiasis affects approximately 10% of lung transplant recipients, most often during the initial hospitalization. It is associated with increased mortality, prolonged hospital stays, and a greater need for surgical re-intervention. These findings highlight the importance of early identification and targeted preventive strategies to improve outcomes in this high-risk population.
METHODS: We conducted a retrospective cohort study using administrative claims data from the OptumLabs® Data Warehouse. We identified LTRs from January 1, 2005, to December 31, 2023, using procedural codes. Exclusion criteria included re-transplantations and pre-transplant IC. We employed multivariable logistic regression to identify risk factors for IC and Cox Proportional Hazard models to assess the impact of IC on mortality.
RESULTS: Among 1279 LTRs, 131 (10.2%) developed IC, primarily during the initial hospitalization for lung transplantation (index hospitalization). The median time to IC diagnosis was 32.0 days following transplant. Post-transplant extra-corporeal membrane oxygenation (ECMO) for more than 8 days was associated with IC (OR: 2.34; 95% CI 1.03 to 5.34). Mortality was higher in LTRs with IC (HR: 2.31; 95% CI: 1.45 to 3.67; p < 0.001). LTRs with IC also had longer hospital stays (median 26.0 days vs. 20.0 days; p < 0.001) and more re-operations (36.7% vs. 27.3%; p = 0.003) compared to those without IC.
CONCLUSION: Invasive candidiasis affects approximately 10% of lung transplant recipients, most often during the initial hospitalization. It is associated with increased mortality, prolonged hospital stays, and a greater need for surgical re-intervention. These findings highlight the importance of early identification and targeted preventive strategies to improve outcomes in this high-risk population.