Lung Transplant Outcome Might Hinge on Hospital Location
Risk of premature death can be much higher at 'high-risk' transplant centers, U.S. study finds
TUESDAY, July 6, 2010 (HealthDay News) -- Five-year survival rates for U.S. lung transplant patients vary widely depending on where they had their operation, a new study finds.
About 1,500 lung transplantations are performed each year at the 61 lung transplantation centers across country, researchers Dr. Gabriel Thabut, of the Mayo Clinic College of Medicine in Rochester, Minn., and colleagues, said in a news release.
In this study, Thabut's team analyzed data from the United Network for Organ Sharing registry on almost 16,000 patients who underwent lung transplantation between 1987 and 2009. Overall, the median (midpoint) survival for patients was 4.9 years. The one-month survival rate was 93.4 percent, and one-, three-, and five-year survival rates were 79.7 percent, 63 percent, and 49.5 percent, respectively.
"Characteristics of donors, recipients, and surgical techniques varied substantially among centers," the researchers said.
After adjusting for these factors, the team found that the risk of death ranged from 30 percent lower at low-risk centers to 70 percent higher at high-risk centers. Five-year survival rates ranged from 30 percent to more than 61 percent.
The study appears in the July 7 issue of the Journal of the American Medical Association.
"The center where a patient undergoes [lung transplant] may be a major determinant of survival rate," the researchers conclude. "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," they add.
Lower-performing centers can learn from those that do better, the team believes. "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 lung transplant recipients, consideration might be given to further regionalizing the [lung transplant] system in the United States," they concluded.
Reports on volume-outcome relationships, however, often have flawed methodology, cautioned Dr. Edward Livingston, of the University of Texas Southwestern Medical Center, Dallas, and Jing Cao of Southern Methodist University in Dallas, in an accompanying editorial. In particular, they wrote, "little attention has been given to the quality of statistical analysis used to support claims" that better outcomes occur at high-volume centers.
There's more on lung transplant at the U.S. National Heart, Lung, and Blood Institute.