Lung Transplant Center Volume Ameliorates Adverse Influence of Prolonged Ischemic Time on Mortality.
The influence of prolonged ischemic time on outcomes after lung transplant is controversial, but no research has investigated ischemic time in the context of center volume. We used data from the United Network for Organ Sharing to estimate the influence of ischemic time on patient survival conditional on center volume in the post-lung allocation score era (2005-2015). The analytic sample included 14 877 adult lung transplant recipients, of whom 12 447 were included in multivariable survival analysis. Patient survival was improved in high-volume centers compared with low-volume centers (log-rank test p = 0.001), although mean ischemic times were longer at high-volume centers (5.16 ± 1.70 h vs. 4.83 ± 1.63 h, p < 0.001). Multivariable Cox proportional hazards regression stratified by transplant center found an adverse influence of longer ischemic time at low-volume centers but not at high-volume centers. At centers performing 50 transplants in the period 2005-2015, for example, 8 versus 6 h of ischemia were associated with an 18.9% (95% confidence interval 6.5-32.7%; p < 0.001) greater mortality hazard, whereas at centers performing 350 transplants in this period, no differences in survival by ischemic time were predicted. Despite longer mean ischemic time at high-volume transplant centers, these centers had favorable patient outcomes and no adverse survival implications of prolonged ischemia.
Department of Pediatrics, The Ohio State University, Columbus, OH.|Department of Internal Medicine, The Ohio State University, Columbus, OH.|Department of Surgery, The Ohio State University, Columbus, OH.|Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH.|Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH.
D
D
Hayes
Department of Surgery, Duke University, Durham, NC.
M G
MG
Hartwig
Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH.|Department of Anesthesiology, The Ohio State University, Columbus, OH.|Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH.
J D
JD
Tobias
Department of Pediatrics, The Ohio State University, Columbus, OH.|Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH.|Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH.
D
D
Tumin
D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D006085:Graft Survival; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007511:Ischemia / Q000503:physiopathology*; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods*
United Network for Organ Sharing (UNOS); health services and outcomes research; ischemia reperfusion injury (IRI); lung transplantation/pulmonology; registry/registry analysis