The Annals of Thoracic Surgery, Vol 56, 343-345, Copyright © 1993 by The Society of Thoracic Surgeons
Determinants of heart-lung transplantation outcomes: results of a consensus survey
RW Evans, DL Manninen, FB Dong, WH Frist and JK Kirklin
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905.
Substantial progress has been made in clinical heart-lung transplantation.
Although outcomes vary across centers, 1-year patient survival is now 59%.
This study was an attempt to assess consensus among transplant program
directors regarding the major determinants of patient outcome. In the
National Cooperative Transplantation Study we evaluated consensus through a
survey of all heart-lung transplant programs active in 1988. Of the
eligible programs, 23 (85%) returned completed surveys. Data on the medical
and surgical determinants of outcome were analyzed. There was considerable
consensus among program directors as to the importance of several factors.
The three most critical predictors of favorable outcomes were periodic
pulmonary function tests to detect rejection (85.7%), avoidance of use of
prednisone during the first 14 days after transplantation (76.2%), and
annual left and right heart catheterization with coronary arteriography
(76.2%). Several approaches were considered undesirable or unnecessary.
These included electrocardiogram as standard rejection monitoring technique
(71.4%), cytoimmunological monitoring as standard rejection monitoring
technique (66.7%), and routine steroid discontinuation after
transplantation (66.7%). On various other treatment approaches there was
little evidence of consensus. These included prophylaxis with acyclovir and
severe bronchiolitis as a criterion for retransplantation. Although
controversial, consensus conferences are one means by which to evaluate
technological innovations. Based on their results, practice guidelines can
be developed to better inform third-party payers on issues related to
transplantation.
