Lung transplant outcomes by surgeon practice and volume

Lung transplants (LT) are performed by surgeons whose practice may include only lung transplants (LT) or lung and heart transplants (L&HT). We examined whether LT outcomes differed by surgeon practice and volume.

We identified all LT in adult U.S. recipients 05/2007-06/2022 using OPTN. We classified surgeons by practice (LT vs. L&HT) and LT volume (2-20, 21-40, 41-60, or >60) and compared post-transplant morbidity and mortality using multivariable regression adjusted for donor, recipient, and transplant characteristics.

Of 635 surgeons, 331 (51.1%) were LT and 304 (47.9%) were L&HT surgeons. They performed 30,223 transplants, including 9807 (32.5%) by LT and 20,416 (67.5%) by L&HT surgeons. Recipients of transplants by L&HT vs. LT surgeons were less likely to receive post-transplant ECMO (7.9% vs. 8.5%; aOR 0.86, 0.76-0.97, p=0.02) but had similar odds of prolonged ventilation (31.3% vs. 31.5%; aOR 1.01, 95% CI 0.94-1.08, p=0.87), reintubation (18.6% vs. 18.3%; aOR 1.04, 0.98-1.11, p=0.20), airway dehiscence (1.5% vs. 1.6%; aOR 1.01., 0.82-1.23, p=0.94), and 1-year rejection (24.1% vs. 23.0%; aOR 1.04, 0.98-1.12, p=0.20), and they had 4% higher risk of 10-year mortality (70.0% vs. 67.6%; aHR 1.04, 95% CI 1.00-1.08, p=0.046). Additionally, performing >60 lung transplants over the study period was associated with 7% lower 5-year mortality compared to performing only 2-20 transplants (aHR 0.93, 95% CI 0.88-0.98, p=0.004).

Surgeons' practice patterns and lung transplant volume were significantly associated with post-transplant mortality, indicating the importance of experience in achieving optimal outcomes for a technically difficult procedure such as a lung transplant.