Jeremiah W Awori Hayanga1, Alena Lira2, Jonathan K Aboagye3, Heather K Hayanga4, Jonathan D'Cunha5. 1. Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA jhayanga@me.com. 2. Department of Surgical Critical Care, MedStar Washington Hospital Center, Washington, DC, USA. 3. Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, PA, USA. 4. Department of Cardiac Anesthesia, Johns Hopkins School of Medicine, Baltimore, MD, USA. 5. Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Abstract
OBJECTIVES: We sought to evaluate the effect of centre volume on survival when extracorporeal membrane oxygenation (ECMO) is used as a bridge to lung transplantation (LTx). METHODS: We performed a retrospective analysis of the United Network for Organ Sharing data on adult lung transplantations performed between 2000 and 2014. Centres were categorized based on volume of transplants into low-, medium- and high-volume centres (1-5, 6-15 and >15, respectively). Baseline characteristics were assessed and a Kaplan-Meier analysis was used to estimate survival with log-rank test. We used multivariate Cox regression analysis to estimate the risk of post-transplant 1-year mortality between centres. RESULTS: A total of 342 adult recipients were bridged on ECMO. Of these recipients, 88 (25.7%) were bridged in low, 89 (26%) in medium and 165 (48.2%) in high-volume centres. Patients in medium-volume centres were more likely to be older compared with those in low-volume and high-volume centres with a median age of 56, 46 and 49 years, respectively. High-volume centres reported the highest proportion (94.6%) of bilateral lung recipients, followed by low-volume (86.4%) and medium-volume centres (77.5%). The 30-day survival for the three groups was similar but 1-year survival was higher in high-volume centres (80.8) compared with medium-volume centres (70.0%) and low-volume centres (61.9%). The risk of 1-year mortality in low-volume centres was higher compared with high-volume centres in adjusted analysis (hazard ratio 2.74, 95% confidence interval 1.61-4.68, P = 0.01). CONCLUSIONS: Lowest volume centres have lowest survival and there exists a volume threshold at which better outcomes are achieved.
OBJECTIVES: We sought to evaluate the effect of centre volume on survival when extracorporeal membrane oxygenation (ECMO) is used as a bridge to lung transplantation (LTx). METHODS: We performed a retrospective analysis of the United Network for Organ Sharing data on adult lung transplantations performed between 2000 and 2014. Centres were categorized based on volume of transplants into low-, medium- and high-volume centres (1-5, 6-15 and >15, respectively). Baseline characteristics were assessed and a Kaplan-Meier analysis was used to estimate survival with log-rank test. We used multivariate Cox regression analysis to estimate the risk of post-transplant 1-year mortality between centres. RESULTS: A total of 342 adult recipients were bridged on ECMO. Of these recipients, 88 (25.7%) were bridged in low, 89 (26%) in medium and 165 (48.2%) in high-volume centres. Patients in medium-volume centres were more likely to be older compared with those in low-volume and high-volume centres with a median age of 56, 46 and 49 years, respectively. High-volume centres reported the highest proportion (94.6%) of bilateral lung recipients, followed by low-volume (86.4%) and medium-volume centres (77.5%). The 30-day survival for the three groups was similar but 1-year survival was higher in high-volume centres (80.8) compared with medium-volume centres (70.0%) and low-volume centres (61.9%). The risk of 1-year mortality in low-volume centres was higher compared with high-volume centres in adjusted analysis (hazard ratio 2.74, 95% confidence interval 1.61-4.68, P = 0.01). CONCLUSIONS: Lowest volume centres have lowest survival and there exists a volume threshold at which better outcomes are achieved.
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