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Transplant center volume and outcomes in lung transplantation for cystic fibrosis


Hayes, Don; Sweet, Stuart C; Benden, Christian; Kopp, Benjamin T; Goldfarb, Samuel B; Visner, Gary A; Mallory, George B; Tobias, Joseph D; Tumin, Dmitry (2017). Transplant center volume and outcomes in lung transplantation for cystic fibrosis. Transplant International, 30(4):371-377.

Abstract

INTRODUCTION: Transplant volume represents lung transplant (LTx) expertise and predicts outcomes, so we sought to determine outcomes related to center volumes in CF.
METHODS: United Network for Organ Sharing data were queried for CF patients receiving bilateral LTx from 2005-2015. Multivariable Cox regression was used to model survival to 1 year and long-term (>1 year) survival, conditional on surviving at least 1 year.
RESULTS: 2,025 patients and 67 centers were included in the analysis. The median annual LTx volumes were 3 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=1,510) demonstrated that greater annual CF LTx volume (HR per 10 LTx=0.66; 95% CI: 0.49, 0.89; p=0.006) but not greater non-CF LTx volume (HR=1.00; 95% CI: 0.96, 1.05; p=0.844) was associated with improved long-term survival in LTx recipients with CF. A Wald interaction test confirmed that CF LTx volume was more strongly associated with long-term outcomes than non-CF LTx volume (p=0.012). Center volume was not associated with 1-year survival.
CONCLUSIONS: CF-specific expertise predicted improved long-term outcomes of LTx for CF, whereas general LTx expertise was unassociated with CF patients' survival. This article is protected by copyright. All rights reserved.

Abstract

INTRODUCTION: Transplant volume represents lung transplant (LTx) expertise and predicts outcomes, so we sought to determine outcomes related to center volumes in CF.
METHODS: United Network for Organ Sharing data were queried for CF patients receiving bilateral LTx from 2005-2015. Multivariable Cox regression was used to model survival to 1 year and long-term (>1 year) survival, conditional on surviving at least 1 year.
RESULTS: 2,025 patients and 67 centers were included in the analysis. The median annual LTx volumes were 3 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=1,510) demonstrated that greater annual CF LTx volume (HR per 10 LTx=0.66; 95% CI: 0.49, 0.89; p=0.006) but not greater non-CF LTx volume (HR=1.00; 95% CI: 0.96, 1.05; p=0.844) was associated with improved long-term survival in LTx recipients with CF. A Wald interaction test confirmed that CF LTx volume was more strongly associated with long-term outcomes than non-CF LTx volume (p=0.012). Center volume was not associated with 1-year survival.
CONCLUSIONS: CF-specific expertise predicted improved long-term outcomes of LTx for CF, whereas general LTx expertise was unassociated with CF patients' survival. This article is protected by copyright. All rights reserved.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Pneumology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:April 2017
Deposited On:19 Jan 2017 16:10
Last Modified:16 Mar 2017 02:03
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:0934-0874
Additional Information:This is the peer reviewed version of the following article: Transplant International, 2017 , which has been published in final form at https://doi.org/10.1111/tri.12911. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-820227.html#terms).
Publisher DOI:https://doi.org/10.1111/tri.12911
PubMed ID:28012223

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