Lung Transplant Outcomes in the Veterans Health Administration

The Veterans Health Administration (VA) provides lung transplant care in collaboration with select academic centers, requiring travel and a shared-care model. This could potentially affect clinical care and survival of patients with end-stage lung disease. Hence, we compared survival after waitlisting and transplant for veterans vs non-veterans and for veterans treated through VA vs non-VA programs.

From January 2006 to March 2020, 31,302 adults were waitlisted and 25,790 received transplants in the Organ Procurement and Transplantation Network lung transplant database. Veterans represented 416 of those (1.3%) waitlisted and 363 (1.4%) of those receiving transplants, with 303 (73%) and 268 (74%) waitlisted and receiving transplants through the VA program, respectively. Survival was assessed after weighted matching.

One-year waitlist survival of veterans vs non-veterans was 83% vs 80% (P = .27), with survival of veterans waitlisted at VA vs non-VA programs of 80% vs 85% at 0.75 year (P = .65). From transplant, 5-year survival of veterans vs non-veterans was 62% vs 58% (P = .065); 5-year survival of veterans receiving transplants at VA vs non-VA programs was 66% vs 61% (P = .39).

Survival from both the time of listing and transplant for all veterans and veterans treated through the VA lung transplant program is at least comparable to outcomes through non-VA programs, suggesting that the VA program facilitates quality care for its patients.