A comparison of outcomes after lung transplantation between European and North American centers

https://doi.org/10.1016/j.healun.2022.07.014Get rights and content

BACKGROUND

With advancements in basic science and clinical medicine, lung transplantation (LT) has evolved rapidly over the last three decades. However, it is unclear if significant regional variations exist in long-term outcomes after LT.

METHODS

To investigate potential differences, we performed a retrospective, comparative cohort analysis of adult patients undergoing deceased donor single or double LT in North America (NA) or Europe between January 2006 and December 2016. Data up to April 2019 were abstracted from the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Registry. We compared overall survival (OS) between North American and European LT centers in a propensity score matched analysis.

RESULTS

In 3,115 well-matched pairs, though 30-day survival was similar between groups (NA 96.2% vs Europe 95.4%, p = 0.116), 5-year survival was significantly higher in European patients (NA 60.1% vs Europe 70.3%, p < 0.001).

CONCLUSIONS

This survival difference persisted in a sensitivity analysis excluding Canadian patients. Prior observations suggest that these disparities are at least partly related to better access to care via universal healthcare models prevalent in Europe. Future studies are warranted to confirm our findings and explore other causal mechanisms. It is likely that potential solutions will require concerted efforts from healthcare providers and policymakers.

Section snippets

Methods

Since a majority of LT are performed in North America (NA) or Europe,4 we performed a retrospective, comparative cohort analysis of adult patients undergoing deceased donor single or double LT in these 2 regions between January 2006 and December 2016. Data up to April 2019 were abstracted from the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Registry. Exclusion criteria included re-transplantation, multiorgan transplantation, prior transplantation of any type,

Results

Overall, 21,777 patients (18,136 NA vs 3,641 Europe) were included in this study. At baseline, European recipients were more likely to be younger than 65 years, more frequently suffered from obstructive lung disease, and had longer ischemic times compared to NA recipients. European lung donors were more than a decade older than the NA cohort. Donor and recipient baseline characteristics are presented in Table 1.

Propensity-score matching resulted in 3,115 well-matched pairs (Table 1). One

Discussion

In the current study, we found significantly better OS after lung transplantation in European patients compared to a contemporaneous, propensity-matched cohort of North American patients. Others have noted similar findings in kidney transplantation.1,2 Furthermore, our sensitivity analysis, which excluded Canadian patients by using the UNOS data, demonstrated an accentuated difference in survival between US and European patients.

A number of donor and recipient related factors can influence

Acknowledgments

This study is funded by National Heart, Lung and Blood Institute R01HL146856-02 (Varun Puri).

Disclosures

None.

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    1

    These authors contributed equally to the manuscript.

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