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Strategic application of modular risk components to safely increase lung transplantation volume
Author(s) -
Pasrija Chetan,
Parchment Nathaniel,
Tran Douglas,
Mackowick Kristen,
Boulos Francesca,
Iacono Aldo,
Kim June,
Griffith Bartley P.,
Sanchez Pablo G.,
Pham Si M.,
Kon Zachary N.
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14874
Subject(s) - medicine , lung transplantation , transplantation , perioperative , lung , surgery
Objectives Considerable growth of individual lung transplant programs remains challenging. We hypothesized that the systematic implementation of modular risk components to a lung transplantation program would allow for expeditious growth without increasing mortality. Methods All consecutive patients placed on the lung transplantation waitlist were reviewed. Patients were stratified by an 18‐month period surrounding the systematic implementation of the modular risk components Era 1 (1/2014‐6/2015) and Era 2 (7/2015‐12/2016). Modular risk components were separately evaluated for donors, recipients, and perioperative features. Results One hundred and thirty‐two waitlist patients (Era 1: 48 and Era 2: 84) and 100 transplants (Era 1: 32 and Era 2: 68) were identified. There was a trend toward decreased waitlist mortality ( P = .07). In Era 2, the use of ex vivo lung perfusion ( P = .05) and donor‐recipient over‐sizing ( P = .005) significantly increased. Moreover, transplantation with a lung allocation score greater than 70 ( P = .05), extracorporeal support ( P = .06), and desensitization ( P = .008) were more common. Transplant rate significantly improved from Era 1 to Era 2 (325 vs 535 transplants per 100 patient years, P = .02). While primary graft dysfunction (PGD) grade 3 at 72 hours ( P = .05) was significantly higher in Era 2, 1‐year freedom from rejection was similar (86% vs 90%, P = .69) and survival (81% vs 95%, P = .02) was significantly greater in Era 2. Conclusions The systematic implementation of a modular risk components to a lung transplantation program can result in a significant increase in center volume. However, measures to mitigate an expected increase in the incidence of PGD must be undertaken to maintain excellent short and midterm outcomes.