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

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BACKGROUND: 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 better prepare them for the demanding post-transplant period. MATERIALS AND METHODS: DAOH was calculated for the year before (DAOH-BF) and two years after first LT (DAOH-AF1, DAOH-AF2) for all patients transplanted in France between 2020 and 2023. Clinical variables were collected to identify predictors of DAOH-AF1 using a two-part model. RESULTS: 1,222 patients were included (56% male; median age 57, IQR 47-62). Median DAOH-BF was 95% (IQR, 89-99%), whereas median DAOH-AF1 declined to 80% (IQR, 64-87%, p < 0.001). Among patients discharged after the transplantation-related hospital stay, connective tissue disease (β = -4.1, p = 0.05) and single-LT (β = -4.0, p = 0.040) were independently associated with lower DAOH-AF1. Median DAOH-AF2 subsequently recovered to 98.6% (IQR, 95.1-100%). CONCLUSION: DAOH is significantly reduced during the first post-LT year, particularly among patients with connective tissue disease and in case of single LT. These findings have direct implications for pre-LT counselling, informing patients about the demanding nature of the first year post-LT while offering reassurance that DAOH improves substantially beyond this period. Identified predictors of lower DAOH-AF1 allow clinicians to further tailor pre-LT information to high-risk subgroups.