National Healthcare Delivery Systems Influence Lung Transplant Outcomes for Cystic Fibrosis

Am J Transplant. 2015 Jul;15(7):1948-57. doi: 10.1111/ajt.13226. Epub 2015 Mar 24.


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.

Keywords: clinical research / practice; epidemiology; health services and outcomes research; insurance; lung transplantation / pulmonology; organ transplantation in general; quality of care / care delivery.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Cohort Studies
  • Cystic Fibrosis / mortality*
  • Cystic Fibrosis / surgery*
  • Delivery of Health Care, Integrated / organization & administration*
  • Delivery of Health Care, Integrated / standards
  • Female
  • Follow-Up Studies
  • Graft Rejection / mortality*
  • Humans
  • International Agencies
  • Lung Transplantation / mortality*
  • Male
  • National Health Programs / organization & administration*
  • National Health Programs / standards
  • Postoperative Complications*
  • Prognosis
  • Quality of Health Care
  • Registries
  • Risk Factors
  • Survival Rate
  • United Kingdom
  • United States