Does Practice Make Perfect? An Analysis of Transplant Centers by Volume and Past Performance

K. W.. Freischlag¹, L. Wendt², P. Ten Eyck², T. J.. Lynch¹, V. Ievlev¹, J. C.. Keech¹, E. V.. Arshava¹, A. M.. Swatek¹, T. Pena³, J. Kelsney-Tait³, K. Parekh¹
¹Department of Cardiothoracic Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa ²Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa ³Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa

Presenting Author(s)

Kyle W. Freischlag, MD, MHS (he/him/his)

General Surgery Categorical Resident
Department of Surgery, University of Iowa Carver College of Medicine
Iowa City, Iowa, United States

Disclosure(s):

Kyle W. Freischlag, MD, MHS: No financial relationships to disclose

Purpose: Approximately 1500 lung transplants (LTs) are performed annually in the United States. However, published reports suggest that outcomes vary based on center experience. We hypothesized that center volume alone is not a good predictor of outcomes, and that past performance plays a role in predicting a center’s outcomes after LT.

Methods: Recipient outcomes from 2016 to 2021 were analyzed. Centers were categorized by historical performance (median survival from 2007 to 2015) and current volume (median annual volume from 2016 to 2021) into “high-volume (HV)” or “low-volume (LV)” and “high-performing (HP)” or “low-performing (LP).”

Results: There were 28,423 LT recipients among the 61 centers from 2007 to 2021. During that time, survival at HV centers was not significantly different from that at LV centers (3-year: HV 72.5% vs. LV 70.9%; P = 0.071). Conversely, subjects from HP centers had significantly better survival rates (3-year HP 74.6% vs. LP 69.6%, P < 0.0001). Center volume did not help predict the risk of death (HR 0.96, 95% [CI] 0.91–1.01, P = 0.13). However, high past performance reduced the risk of death (HR 0.91, 95% CI 0.85–1.00; P = 0.048) and showed a greater benefit at centers with high volumes (P = 0.020).

Conclusion: Center volume alone does not predict center performance in the modern era. LT recipients transplanted at centers with a better past performance had better outcomes. A high past performance is an even greater benefit for patient survival outcomes within centers with higher volumes.

Identify the source of the funding for this research project: National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002537