Ruck Jessica M, Feng Shi Nan, Bowring Mary G, Zhou Alice L, Ha Jinny S, Polanco Antonio, Merlo Christian A, Bush Errol L
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
JHLT Open. 2025 Mar 20;8:100237. doi: 10.1016/j.jhlto.2025.100237. eCollection 2025 May.
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.
肺移植（LT）由外科医生实施，他们的业务范围可能仅包括肺移植（LT）或肺与心脏移植（L&HT）。我们研究了肺移植结果是否因外科医生的业务范围和手术量而有所不同。
我们使用器官共享联合网络（OPTN）识别了2007年5月至2022年6月期间美国成年受者的所有肺移植情况。我们根据业务范围（LT与L&HT）和肺移植手术量（2 - 20例、21 - 40例、41 - 60例或>60例）对外科医生进行分类，并使用针对供体、受体和移植特征进行调整的多变量回归比较移植后的发病率和死亡率。
在635名外科医生中，331名（51.1%）是肺移植外科医生，304名（47.9%）是肺与心脏移植外科医生。他们共进行了30223例移植手术，其中肺移植外科医生进行了9807例（32.5%），肺与心脏移植外科医生进行了20416例（67.5%）。与肺移植外科医生相比，肺与心脏移植外科医生的受者接受移植后体外膜肺氧合（ECMO）治疗的可能性较小（7.9%对8.5%；校正后比值比[aOR]为0.86，95%置信区间[CI]为0.76 - 0.97，p = 0.02），但长时间通气（31.3%对31.5%；aOR为1.01，95% CI为0.94 - 1.08，p = 0.87）、再次插管（18.6%对18.3%；aOR为1.04，0.98 - 1.11，p = 0.20）、气道裂开（1.5%对1.6%；aOR为1.01，0.82 - 1.23，p = 0.94）和1年排斥反应（24.1%对23.0%；aOR为1.04，0.98 - 1.12，p = 0.20）的几率相似，且他们10年死亡率风险高4%（70.0%对67.6%；校正后风险比[aHR]为1.04，95% CI为1.00 - 1.08，p = 0.046）。此外，与仅进行2 - 20例肺移植相比，在研究期间进行>60例肺移植与5年死亡率降低7%相关（aHR为0.93，95% CI为0.88 - 0.98，p = 0.004）。
外科医生的业务模式和肺移植手术量与移植后死亡率显著相关，表明经验对于像肺移植这样技术难度大的手术实现最佳结果具有重要意义。
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