Five-year competing-risk analysis of infectious and noninfectious complications after lung transplantation: Real-world evidence from a multicenter EHR-based cohort

This study evaluates the 5-year incidence of major post-transplant outcomes using a competing-risks framework. We analyzed data from 10,648 lung transplantation (LTx) recipients using the TriNetX U.S. Collaborative Network (January 1, 2015, to December 31, 2024). The Aalen-Johansen method was used to estimate the cumulative incidence function (CIF) of post-transplant complications. Infectious complications had the highest 5-year CIF (30.88%) and steepest annual trend (5.79%), slightly exceeding noninfectious complications (30.28%, 5.69%). Mortality reached 10.62%, and malignancies 6.72%. Cytomegalovirus showed the highest infectious burden (CIF 17.02%, annual trend 3.40%), with a steep rise within the first 180 days. Bacterial pneumonia followed a slower but sustained trajectory (CIF 9.1%, 1.8% annually). Statistical analyses confirmed significant differences across all outcomes (p < 0.001). Infectious and noninfectious complications dominate the post-LTx landscape and follow distinct temporal trajectories. Our data underscore the need for dynamic, risk-based surveillance and individualized prevention strategies to optimize long–term transplant outcomes.