National Healthcare Delivery Systems Influence Lung Transplant Outcomes for Cystic Fibrosis

Merlo, Christian, Clark, Stephen, Arnaoutakis, George, Yonan, Nizar, Thomas, Debra, Simon, Andre, Thompson, Richard, Thomas, Helen, Orens, Jonathan and Shah, Ashish (2015) National Healthcare Delivery Systems Influence Lung Transplant Outcomes for Cystic Fibrosis. American Journal of Transplantation, 15 (7). pp. 1948-1957. ISSN 1600 6135

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Abstract

Successful lung transplantation (LTx) depends on multiple components of healthcare delivery and performance. Therefore, we conducted an international registry analysis to compare post-LTx outcomes for cystic fibrosis (CF) patients using the UNOS registry in the United States and the National Health Service (NHS) Transplant Registry in the United Kingdom. Patients with CF who underwent lung or heart–lung transplantation in the United States or United Kingdom between January 1, 2000 and December 31, 2011 were included. The primary outcome was all-cause mortality. Kaplan–Meier analysis and Cox proportional hazards regression evaluated the effect of healthcare system and insurance on mortality after LTx. 2,307 US LTx recipients and 451 individuals in the United Kingdom were included. 894 (38.8%) US LTx recipients had publically funded Medicare/Medicaid insurance. US private insurance and UK patients had improved median predicted survival compared with US Medicare/Medicaid recipients (p < 0.001). In multivariable Cox regression, US Medicare/Medicaid insurance was associated with worse survival after LTx (US private: HR0.78,0.68–0.90,p = 0.001 and UK: HR0.63,0.41–0.97, p = 0.03). This study in CF patients is the largest comparison of LTx in two unique health systems. Both the United States and United Kingdom have similar early survival outcomes, suggesting important dissemination of best practices internationally. However, the performance of US public insurance is significantly worse and may put patients at risk.

Item Type:	Article
Uncontrolled Keywords:	clinical research / practice, health services and outcomes research;organ transplantation in general;lung transplantation / pulmonology, epidemiology, insurance, quality of care / care delivery
Subjects:	B100 Anatomy, Physiology and Pathology
Department:	Faculties > Health and Life Sciences > Applied Sciences
Depositing User:	Becky Skoyles
Date Deposited:	26 May 2015 15:02
Last Modified:	12 Oct 2019 18:30
URI:	http://nrl.northumbria.ac.uk/id/eprint/22586

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