D22-05 Racial and Ethnic Differences in the Indications and Outcomes of Lung Transplantation: Analysis From the National Inpatient Sample (2018 - 2019)

Rationale Lung transplantation is a life-saving therapy for end-stage lung disease, yet racial and ethnic disparities in indications and outcomes remain poorly defined in large national datasets. We used the National Inpatient Sample (NIS) to examine contemporary patterns in recipient characteristics, indications, and outcomes by race/ethnicity. Methods We performed a retrospective analysis of adult hospitalizations with procedure codes for lung transplantation in the NIS (2018-2021). Race/ethnicity was categorized per NIS definitions (White, Black, Hispanic, Asian/Pacific Islander, Native American, other). Demographics, indication for transplant, and hospital characteristics were analyzed. Comorbidity burden was quantified using the Elixhauser Comorbidity Sum. Primary outcomes were length of stay (LOS), in-hospital mortality, discharge disposition, and total hospital charges. Survey-weighted generalized linear models (family = gamma, link = log) adjusted for age, sex, indication, comorbidities, and hospital factors. Results An estimated 10,000 (weighted national estimate) adult lung transplant hospitalizations were identified: 74% White, 9% Black, 11% Hispanic, 2% Asian/Pacific Islander, 0.5% Native American, and 3% other. Median age was 62 (IQR 54-67) years. Most transplants occurred in the East-North Central (19%), South-Atlantic (18%), and Mid-Atlantic (17%) hospital divisions. Indications included Interstitial Lung Disease (ILD, 48%), Pulmonary Hypertension (3%), Chronic Obstructive Lung Disease (7%), Cystic Fibrosis (5%), Bronchiectasis (2%), and others (34%). Median LOS was 22 days (IQR 14-39). In unadjusted comparison by race, LOS was longest for Black (32 days) and Hispanic (27 days) recipients; Whites, Asians/Pacific Islanders and Native Americans were 21, 20 and 16 days, respectively. Unadjusted in-hospital mortality among each race was similar for Whites, Blacks, and Hispanics (∼5%), but higher among Asian/Pacific Islanders (10%) and Native Americans (9%), p = 0.622. Median total hospital charges were $807,000, highest among Asian/Pacific Islanders ($1.30M) and Hispanics ($1.11M). Overall, 38% of recipients were discharged home, 34% with home health services, and 22% to skilled or intermediate care facilities. In adjusted models (reference = White), Black race was associated with a LOS ratio of 1.11 (95% CI 0.97-1.27, p = 0.12) and Hispanic race with 1.17 (95% CI 1.00-1.36, p = 0.04). Adjusted odds of in-hospital mortality were lower for Blacks (OR 0.57, 95% CI 0.26-1.26) but higher for other race groups (p > 0.05). Conclusions Significant racial and ethnic differences exist in indications and short-term outcomes after lung transplantation, suggesting potential disparities in disease severity, access, and peri-operative care. Further work is needed to identify structural and center-level factors contributing to these inequities and to promote equity in lung transplant care. This abstract is funded by: None