PURPOSE: The inherent risk in increasing lung transplant volume is possible poor outcome related to acceptance of high risk recipients and donors. The purpose of this study was to analyze effects of increasing volumes on outcomes.
METHODS: A retrospective analysis using prospectively collected transplant data base was performed on 724 lung and heart-lung transplants from 1999 to 2008 at our institution.
RESULTS: We witnessed doubling of our volumes from 1999-2004 (Low volume era: average 47 cases/year, range 36 to 61, n=284) to 2005-2008 (High volume era: average 110 cases/year, range 91 to 127, n=440). Recipient and donor age was higher (p<0.05) in high vs. low volume era (551 vs. 511, and 381 vs. 361 years, respectively). We performed more idiopathic pulmonary fibrosis (26% vs. 19%) and re-transplantation (6% vs. 3%) compared to less emphysema (33% vs. 40%) in high vs. low volume era (p<0.05). The graft ischemic time was longer (p<0.05) in high vs. low volume era (3364 vs. 3015 minutes), indicating our acceptance of donors from remote regions. Double lung transplants were performed more frequently in high vs. low volume era (67% vs. 45%, p<0.05), single lung transplants less frequently (29% vs. 51%, p<0.05) and heart-lung transplants similarly (4.3% vs. 3.5%, p=0.7). No difference was observed in survival for high vs. low volume era with 92% vs. 88% at 90 days, 81% vs. 80% at 1-year, and 68% vs. 64% at 3-year (p=0.4). In 2006, with increased volume, our 1-year survival decreased to 74%, but improved to 80% and 85% for 2007 and 8, while maintaining our volume.
CONCLUSION: Lung transplant volume can be increased while maintaining good outcome by appropriately aggressive strategy of accepting carefully selected expanded criteria recipients and maximizing donor utilization with meticulous surgical techniques. Caution needs to be exercised to avoid poor outcome when a lung transplant center intends to increase volume.
CLINICAL IMPLICATIONS: Strategies to increase lung transplant volume while maintaining outcomes will be delivered.
DISCLOSURE: Yoshiya Toyoda, No Financial Disclosure Information; No Product/Research Disclosure Information