Lung Transplant Outcomes in the Veterans Health Administration

Abstract

Background: The Veterans Health Administration (VA) provides lung transplant care in collaboration with select academic centers, requiring travel and a shared-care model. This could potentially affect clinical care and survival in end-stage lung disease patients. Hence, we compare survival after waitlisting and transplant among veterans vs non-veterans and veterans treated through VA vs non-VA programs.

Methods: From 1/2006 to 3/2020, 31,302 adults were waitlisted and 25,790 transplanted in the Organ Procurement and Transplant Network lung transplant database. Veterans comprised 416 of those (1.3%) waitlisted and 363 (1.4%) of those transplanted, with 303 (73%) and 268 (74%) waitlisted and transplanted through the VA program, respectively. Survival was assessed following weighted matching.

Results: One-year waitlist survival of veterans vs non-veterans was 83% vs 80% (P=.27), with survival of veterans waitlisted at VA vs non-VA programs of 80% vs 85% at 0.75 years (P=.65). From transplant, five-year survival of veterans vs non-veterans was 62% vs 58% (P=.065), with five-year survival of veterans transplanted at VA vs non-VA programs of 66% vs 61% (P=.39).

Conclusions: Survival from both the time of listing and transplant for all veterans and veterans treated through the VA lung transplant program are at least comparable to outcomes through non-VA programs, suggesting that the VA program facilitates quality care for its patients.