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A comparison of outcomes after lung transplantation between European and North American centers
The Journal of Heart and Lung Transplantation ( IF 8.9 ) Pub Date : 2022-07-21 , DOI: 10.1016/j.healun.2022.07.014
Zhizhou Yang 1 , Tsuyoshi Takahashi 1 , Yuriko Terada 1 , Bryan F Meyers 1 , Benjamin D Kozower 1 , G Alexander Patterson 1 , Ruben G Nava 1 , Ramsey R Hachem 2 , Chad A Witt 2 , Derek E Byers 2 , Hrishikesh S Kulkarni 2 , Rodrigo Vazquez Guillamet 2 , Yan Yan 3 , Su-Hsin Chang 3 , Daniel Kreisel 1 , Varun Puri 1
Affiliation  

BACKGROUND

With advancements in basic science and clinical medicine, lung transplantation (LT) has evolved rapidly over the last three decades. However, it is unclear if significant regional variations exist in long-term outcomes after LT.

METHODS

To investigate potential differences, we performed a retrospective, comparative cohort analysis of adult patients undergoing deceased donor single or double LT in North America (NA) or Europe between January 2006 and December 2016. Data up to April 2019 were abstracted from the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Registry. We compared overall survival (OS) between North American and European LT centers in a propensity score matched analysis.

RESULTS

In 3,115 well-matched pairs, though 30-day survival was similar between groups (NA 96.2% vs Europe 95.4%, p = 0.116), 5-year survival was significantly higher in European patients (NA 60.1% vs Europe 70.3%, p < 0.001).

CONCLUSIONS

This survival difference persisted in a sensitivity analysis excluding Canadian patients. Prior observations suggest that these disparities are at least partly related to better access to care via universal healthcare models prevalent in Europe. Future studies are warranted to confirm our findings and explore other causal mechanisms. It is likely that potential solutions will require concerted efforts from healthcare providers and policymakers.



中文翻译:

欧洲和北美中心肺移植后结果的比较

背景

随着基础科学和临床医学的进步,肺移植(LT)在过去三十年中迅速发展。然而,尚不清楚 LT 后的长期结果是否存在显着的区域差异。

方法

为了调查潜在差异,我们对 2006 年 1 月至 2016 年 12 月期间在北美 (NA) 或欧洲接受已故捐献者单次或双次 LT 的成年患者进行了回顾性比较队列分析。截至 2019 年 4 月的数据摘自国际癌症协会心肺移植 (ISHLT) 胸器官登记处。我们通过倾向评分匹配分析比较了北美和欧洲 LT 中心的总生存期 (OS)。

结果

在 3,115 对匹配良好的患者中,虽然各组之间的 30 天生存率相似(NA 96.2% vs 欧洲 95.4%,p = 0.116),但欧洲患者的 5 年生存率显着更高(NA 60.1% vs 欧洲 70.3%,p = 0.116) < 0.001)。

结论

在排除加拿大患者的敏感性分析中,这种生存差异仍然存在。先前的观察表明,这些差异至少部分与通过欧洲盛行的全民医疗保健模式更好地获得护理有关。未来的研究有必要证实我们的发现并探索其他因果机制。潜在的解决方案可能需要医疗保健提供者和政策制定者的共同努力。

更新日期:2022-07-21
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