Study finds wide variation in 5-year patient survival rates for lung transplantation centers

Jul 06, 2010

There is significant variation among lung transplant centers in the U.S. in the 5-year survival rate of patients, with a higher number of procedures performed at a center only partly associated with longer survival of patients, according to a study in the July 7 issue of JAMA.

There are approximately 1,500 lung transplantations (LT) performed annually at 61 LT centers currently active in the United States. "Although LT provides the only option for improved survival for patients with many end-stage lung diseases, the complexity of this intervention—both in terms of perioperative [around the time of surgery] approach and in long-term care— suggests that the center where the patient undergoes LT might influence outcome," the authors write. "Although case loads vary substantially among U.S. lung transplant centers, the impact of center effects on patient outcomes following is unknown."

Gabriel Thabut, M.D., Ph.D., of the Mayo Clinic College of Medicine, Rochester, Minn., and colleagues conducted a study to assess the amount of variability in long-term survival among centers performing LT in the United States, and to examine the potential reasons for this variability. The study included an analysis of data from the United Network for Organ Sharing registry for 15,642 adult patients undergoing lung transplantation between 1987 and 2009 in 61 U.S. transplantation centers still active in 2008. Nineteen centers (31.1 percent) performed between 1 and 10 lung transplantations; 18 centers (29.5 percent), from 11 to 25 transplantations; 20 centers (32.8 percent), from 26 to 50 transplantations; and 4 centers (6.6 percent), more than 50 transplantations.

Median (midpoint) survival for the patients was 4.9 years. One-month and 1-, 3-, and 5-year were 93.4 percent, 79.7 percent, 63.0 percent, and 49.5 percent, respectively. "Characteristics of donors, recipients, and surgical techniques varied substantially among centers," the authors write. After adjustment for these factors, marked variability remained among centers, with risks of death ranging from 30 percent lower to about 70 percent higher for low- vs. high-risk centers, for 5-year survival rates of 30.0 percent to 61.1 percent.

"Higher lung transplantation volumes were associated with improved long-term survival and accounted for 15 percent of among-center variability; however, variability in center performance remained significant after controlling for procedural volume," the researchers write. They also found that several low-volume centers achieved good outcomes, suggesting that volume alone does not determine performance.

"This study of all LTs performed in the United States reveals clinically and statistically significant variability among centers in survival after transplantation. Thus, the center where a patient undergoes LT may be a major determinant of survival rate. The observation that this variability among centers remains after controlling for differences in the selection of donors, recipients, or surgical approaches suggests that centers may exhibit true differences in the quality of care provided during or following transplantation."

"There is a great need to explore practices at high-performing centers with the goal of exporting beneficial practices to lower-performing centers. If such efforts do not equalize outcomes for recipients, consideration might be given to further regionalizing the LT system in the United States," the authors conclude.

Explore further: Liver transplant recipient marks 25th anniversary

More information: JAMA. 2010;304[1]:53-60.

add to favorites email to friend print save as pdf

Related Stories

Study shows liver transplant center impacts patient outcomes

May 03, 2010

For patients in need of a liver transplant, their choice of a transplant center can make a noteworthy difference in their outcomes, according to a Mayo Clinic study presented at the American Transplant Congress under way ...

Study finds good outcomes for older lung transplant patients

Feb 04, 2008

In the world of organ donation, it has been common practice to exclude older patients from receiving transplants because of limited donor supply and lower survival rates. However, patients such as Lois Tumanello, who received ...

Recommended for you

Doctor behind 'free radical' aging theory dies

Nov 25, 2014

Dr. Denham Harman, a renowned scientist who developed the most widely accepted theory on aging that's now used to study cancer, Alzheimer's disease and other illnesses, has died in Nebraska at age 98.

Mexican boy who had massive tumor recovering

Nov 25, 2014

An 11-year-old Mexican boy who had pieces of a massive tumor removed and who drew international attention after U.S. officials helped him get treatment in the southwestern U.S. state of New Mexico is still recovering after ...

New medical device to make the mines safer

Nov 21, 2014

Dehydration can be a serious health issue for Australia's mining industry, but a new product to be developed with input from Flinders University's Medical Device Partnering Program (MDPP) is set to more effectively ...

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.