Low one-Year survival rate for University Hospital lung transplants prompts inspection

By Lisa Rosetta

The Salt Lake Tribune

January 15, 2008

Survival Rates

These are University Hospital's lung transplant program survival rates from 2002 to 2006. All one-year survival rates are a three-year average

2002: 9 transplants; 85.71 percent one-year survival rate

2003: 9 transplants; 70 percent one-year survival rate

2004: 12 transplants; 66.6 percent one-year survival rate

2005: 6 transplants; 59 percent one-year survival rate

2006: 4 transplants; 62.5 percent one-year survival rate

Source: Scientific Registry of Transplant Recipients

For University Hospital's lung transplant program, 2004 was a tough year. Twelve people - some considered high risk - got new lungs; half died within a year of their transplant.

Today, it is still dragging the U.'s survival statistics below the national average, and has the hospital turning the riskiest patients away.

The Scientific Registry of Transplant Recipients' latest data, released Friday, shows the U.'s average one-year survival rate for the years 2004 through 2006 was 59 percent, compared with the United Network for Organ Sharing's (UNOS) expected survival rate of 85 percent.

Barbara Cahill, medical director of lung transplantation and a pulmonary critical care physician, said because the U. had such a small volume of patients between 2004 and 2006, the numbers were skewed.

In 2005 and 2006, for instance, the U. performed only six and four transplants, respectively - numbers low enough to prompt a two-day visit in December from UNOS, which has the authority to revoke a program's certification as a transplant center.

"They [2003 and 2004] were bad years for us in terms of outcome, in terms of patient deaths," Cahill said, "and I can assure you it has been pretty fully vetted at both the regional and national level, and personal inspection level."

UNOS' primary concern during its visit wasn't with the quality of care being delivered by the program, but rather with boosting the lung program's patient volume to ensure clinical competency, Cahill said. Both UNOS and Medicare require a minimum of 10 transplants a year.

Despite one of the lower organ wait-list times in the county, the U.'s program has seen its patient numbers dwindle - a trend, Cahill said, that is now being reversed. During the calendar year 2007, she said, the U. performed 14 lung transplants.

And, Cahill added, the program's one-year patient survival rate in 2007 was at least 80 percent, which is at or above the national average. The Scientific Registry of Transplant Recipients' reports, released every six months, should reflect that in its future three-year averages.

"They [UNOS] were very pleased with us," she said. "I felt reassured that we were on the right track."

Added Lonnie Smith, manager of the U.'s solid organ transplant program, "It [the UNOS visit] is painful. It's a lot of work . . . but in the end it was a good experience for us."

Cahill said she plans to schedule visits with physicians and programs around the state and throughout the Intermountain West to continue increasing patient referrals.

And, acting on UNOS' advice, the U. now refers its high risk patients to nearby programs in California, Colorado and Washington - ones with large enough patient volumes that a single death will not skew their one-year survival rates.

Copyright © 2008 The Salt Lake Tribune.

This article posted March 16, 2008.