A Novel Patient-Centered “Intention-To-Treat” Metric of U.S. Lung Transplant Center Performance

5 years ago

A Novel Patient-Centered “Intention-To-Treat” Metric of U.S. Lung Transplant Center Performance

Dawn A. Maldonado, David J. Lederer, Arindam RoyChoudhury

Despite the importance of pre-transplant outcomes, one-year post-transplant survival is typically considered the primary metric of lung transplant center performance in the U.S.. We designed a novel lung transplant center performance metric that incorporates both pre- and post-transplant survival time. We performed an ecologic study of 12,187 lung transplant candidates listed at 56 U.S. lung transplant centers between 2006 and 2012. We calculated an “intention-to-treat” survival (ITTS) metric as the percentage of waiting list candidates surviving at least one year after transplantation. The median center-level 1-year post-transplant survival rate was 84.1%, and the median center-level ITTS was 66.9% (mean absolute difference 19.6%, 95% limits of agreement 4.3 to 35.1%). All but 10 centers had ITTS values that were significantly lower than 1-year post-transplant survival rates. Observed ITTS was significantly lower than expected ITTS for 7 centers. These data show that one-third of lung transplant candidates do not survive one year after transplantation, and that 12% of centers have lower than expected ITTS. An “intention-to-treat survival” metric may provide a more realistic expectation of patient outcomes at transplant centers and may be of value to transplant centers and policymakers. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/ajt.14486