Lung Transplant Outcomes by Surgeon Practice and Volume

Abstract

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 transplant 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 9,807 (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.