Survival in pediatric lung transplantation: The effect of center volume and expertise

• Published in: The Journal of heart and lung transplantation Vol. 34; no. 8; pp. 1073 - 1081
• Main Authors: Khan, Muhammad S., MD, Zhang, Wei, PhD, Taylor, Rachel A., BA, Dean McKenzie, E., MD, Mallory, George B., MD, Schecter, Marc G., MD, Morales, David L.S., MD, Heinle, Jeffrey S., MD, Adachi, Iki, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2015
• Subjects: Adolescent; Adult; Age Factors; center volume; center-type; Child; Child, Preschool; Clinical Competence; Female; Graft Survival; Hospitals, High-Volume; Hospitals, Low-Volume; Humans; Lung Diseases - mortality; Lung Diseases - surgery; lung transplantation; Lung Transplantation - statistics & numerical data; Male; outcomes; pediatrics; Retrospective Studies; risk-factor analysis; Surgery; survival analysis; Survival Rate; Tissue and Organ Procurement - organization & administration; Treatment Outcome; center volume; risk-factor analysis; survival analysis; outcomes; pediatrics; lung transplantation; center-type
• DOI: 10.1016/j.healun.2015.03.008
• ISSN: 1053-2498

Background Institutional operative volume has been shown to impact outcomes of various procedures including lung transplantation (LTx). We sought to determine whether this holds true with pediatric LTx by comparing outcomes of adult centers (with larger overall volume) to those of pediatric centers (with smaller volume but more pediatric-specific experience). Methods A retrospective analysis of the Organ Procurement and Transplant Network data was performed. Centers were categorized as either adult (LTx volume predominantly in adult patients), high-volume pediatric (HVP, ≥4 LTxs/year), or low-volume pediatric (LVP, <4 LTxs/year). Outcomes were compared in “younger children” (<12 years) and “older children and adolescents” (12 to 17 years). Results In total, 1,046 pediatric LTxs were performed between 1987 and 2012 at 62 centers (adult 51 [82%], HVP 3 [5%], LVP 8 [13%]). Although adult centers had larger overall LTx volume, their pediatric experiences were severely limited (median 1/year). In younger children, HVP centers were significantly better than LVP centers for patient survival (half-life: 7.3 vs 2.9 years, p = 0.002). Similarly, in older children and adolescents, HVP centers were significantly better than adult centers for patient survival (half-life: 4.6 vs 2.5 years, p = 0.001). Of note, even LVP centers tended to have longer patient survival than adult centers ( p = 0.064). Multivariable analysis identified adult centers as an independent risk factor for graft failure (hazard ratio: 1.5, p < 0.001) as with LVP (hazard ratio: 1.3, p = 0.0078). Conclusions Despite larger overall clinical volume, outcomes among pediatric LTx recipients in adult centers are not superior to those of pediatric centers. Not only center volume but pediatric-specific experience has an impact on outcomes in pediatric LTx.