Open AccessTransplant center volume and outcomes in lung transplantation for cystic fibrosis
Author(s) -
Hayes Don,
Sweet Stuart C.,
Benden Christian,
Kopp Benjamin T.,
Goldfarb Samuel B.,
Visner Gary A.,
Mallory George B.,
Tobias Joseph D.,
Tumin Dmitry
Publication year - 2017
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12911
Subject(s) - medicine , interquartile range , cystic fibrosis , lung transplantation , proportional hazards model , transplantation , cohort , single center , survival analysis , gastroenterology , surgery
Summary Transplant volume represents lung transplant ( LT x) expertise and predicts outcomes, so we sought to determine outcomes related to center volumes in cystic fibrosis ( CF ). United Network for Organ Sharing data were queried for patients with CF in the United States (US) receiving bilateral LT x from 2005 to 2015. Multivariable Cox regression was used to model survival to 1 year and long‐term (>1 year) survival, conditional on surviving at least 1 year. A total of 2025 patients and 67 centers were included in the analysis. The median annual LT x volumes were three in CF [interquartile range ( IQR ): 2, 6] and 17 in non‐ CF ( IQR : 8, 33). Multivariable Cox regression in cases with complete data and surviving at least 1 year ( n = 1510) demonstrated that greater annual CF LT x volume ( HR per 10 LT x = 0.66; 95% CI : 0.49, 0.89; P = 0.006) but not greater non‐ CF LT x volume ( HR = 1.00; 95% CI : 0.96, 1.05; P = 0.844) was associated with improved long‐term survival in LT x recipients with CF . A Wald interaction test confirmed that CF LT x volume was more strongly associated with long‐term outcomes than non‐ CF LT x volume ( P = 0.012). In a US cohort, center volume was not associated with 1‐year survival. CF ‐specific expertise predicted improved long‐term outcomes of LT x for CF , whereas general LT x expertise was unassociated with CF patients’ survival.