Assessment of postoperative outcomes of prescription benzodiazepine use in lung transplant recipients.

BACKGROUND

The use of prescribed benzodiazepine (BZD) has been associated with adverse outcomes, including morbidity and mortality, in certain groups of solid organ transplant recipients. However, its impact on outcomes in lung transplant patients has not been well established. This retrospective study explores the survival rates and mortality risk factors in lung transplant recipients with preoperative BZD prescriptions.

METHODS

This study included an institutional lung transplant database between January 2018 and May 2024. Data were collected on patient characteristics, pretransplant laboratory values, and postoperative outcomes, including rejection and survival. Chi-squared, one-way analysis of variance (ANOVA), Kruskal-Wallis, Kaplan-Meier, and Wilcoxon signed-rank tests were used for analysis.

RESULTS

During the study period, 399 patients underwent lung transplantation. BZD use within 30 days prior to lung transplantation was reported in 141 patients (35.3%): 35 of 141 (24.8%) had BZD ≥2 mg (high-BZD) and 106 of 141 (75.2%) had BZD <2 mg (low-BZD). The high-BZD cohort had younger patients [mean: 47.8±13.5 62.3±9.8 (low-BZD) 59.4±12.1 (no BZD) years, P<0.001], more bilateral lung transplants [94.3% 57.5% (low-BZD) 59.7% (no BZD), P<0.001], and higher lung allocation scores [mean: 79.6±17.6 55.24±17.9 (low-BZD) 51.6±17.0 (no BZD), P<0.001] than their counterparts. There was no significant difference in one-year survival between the high-BZD cohort and their counterparts [84.9% 88.1% (low-BZD) 88.3% (no BZD), P=0.61]. However, intensive care unit (ICU) stay {median: 15 [interquartile range (IQR), 10-28] 8 (IQR, 5-16, low-BZD) 7 (IQR, 4-14, no BZD) days, P<0.001}, post-transplant ventilator period [median: 4 (IQR, 2-14) 2 (IQR, 1-4, low-BZD) 2 (IQR, 1-3, no BZD) days, P=0.003] and hospital stay [median: 32 (IQR, 17-42) 18 (IQR, 12-32, low-BZD) 16 (IQR, 11-29, no BZD) days, P=0.002] were significantly longer in the high BZD cohort. The incidence of primary graft dysfunction (PGD) in any grade was not significantly higher in the high BZD cohort [hazard ratio (HR) =1.39; 95% confidence interval (CI): 0.68-2.84; P=0.37], but PGD grade 3 was significantly higher in the high BZD cohort (HR =2.73; 95% CI: 1.20-6.22; P=0.02).

CONCLUSIONS

This study highlights that preoperative BZD ≥2 mg use in lung transplant patients could be attributed to a higher rate of PGD grade 3 and prolonged hospital stay after lung transplantation. Appropriate weaning of BZD may be needed to minimize the risk of prolonged ICU stay and morbidity.