Lung transplant outcomes by surgeon practice and volume
Objective: Lung transplants (LT) are performed by surgeons whose practice may include only lung transplants (LT) or lung and heart transplants (L&HT). We examined whether LT outcomes differed by surgeon practice and volume. Methods: We identified all LT in adult U.S. recipients 05/2007–06/2022 u...
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| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-05-01
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| Series: | JHLT Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425000321 |
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| Summary: | Objective: Lung transplants (LT) are performed by surgeons whose practice may include only lung transplants (LT) or lung and heart transplants (L&HT). We examined whether LT outcomes differed by surgeon practice and volume. Methods: We identified all LT in adult U.S. recipients 05/2007–06/2022 using OPTN. We classified surgeons by practice (LT vs. L&HT) and LT volume (2–20, 21–40, 41–60, or >60) and compared post-transplant morbidity and mortality using multivariable regression adjusted for donor, recipient, and transplant characteristics. Results: Of 635 surgeons, 331 (51.1%) were LT and 304 (47.9%) were L&HT surgeons. They performed 30,223 transplants, including 9807 (32.5%) by LT and 20,416 (67.5%) by L&HT surgeons. Recipients of transplants by L&HT vs. LT surgeons were less likely to receive post-transplant ECMO (7.9% vs. 8.5%; aOR 0.86, 0.76–0.97, p=0.02) but had similar odds of prolonged ventilation (31.3% vs. 31.5%; aOR 1.01, 95% CI 0.94–1.08, p=0.87), reintubation (18.6% vs. 18.3%; aOR 1.04, 0.98–1.11, p=0.20), airway dehiscence (1.5% vs. 1.6%; aOR 1.01., 0.82–1.23, p=0.94), and 1-year rejection (24.1% vs. 23.0%; aOR 1.04, 0.98–1.12, p=0.20), and they had 4% higher risk of 10-year mortality (70.0% vs. 67.6%; aHR 1.04, 95% CI 1.00–1.08, p=0.046). Additionally, performing >60 lung transplants over the study period was associated with 7% lower 5-year mortality compared to performing only 2–20 transplants (aHR 0.93, 95% CI 0.88–0.98, p=0.004). Conclusions: Surgeons’ practice patterns and lung transplant volume were significantly associated with post-transplant mortality, indicating the importance of experience in achieving optimal outcomes for a technically difficult procedure such as a lung transplant. |
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| ISSN: | 2950-1334 |