Variation in survival rates for lung transplantation centres

There is significant variation among lung transplant centres in the five-year survival rate of patients, with a higher number of procedures performed at a centre only partly associated with longer survival of patients, according to a new American study.

Doctors assessed the amount of variability in long-term survival among centres performing lung transplants 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 US transplantation centres still active in 2008. Of the 61 centres studied: 19 centres performed between one and 10 lung transplantations per year; 18 centres performed between 11 and 25 transplantations; 20 centres performed between 26 and 50 transplantations; and four centres performed more than 50 transplantations per year.

The median survival for all patients was 4.9 years. One-month and one-, three- and five-year survival rates were 93.4 per cent, 79.7 per cent, 63 per cent and 49.5 per cent, respectively.

“Characteristics of donors, recipients, and surgical techniques varied substantially among centres,” the study’s authors reported. “Higher lung transplantation volumes were associated with improved long-term survival and accounted for 15 per cent of among-centre variability; however, variability in centre performance remained significant after controlling for procedural volume,” the researchers reported.

They also found that several low-volume centres achieved good outcomes, suggesting that volume alone does not determine performance.

“There is a great need to explore practices at high-performing centres with the goal of exporting beneficial practices to lower-performing centres. If such efforts do not equalise outcomes for lung transplant recipients, consideration might be given to further regionalising the lung transplant system in the United States,” the study’s authors concluded.

JAMA 2010;304:53-60