Lung-transplantation centers

Question

Dear ladies and gentlemen,

as in the near future I will have to reconcile with the idea of a lung transplantation (LTx), the question of "where?" is coming up. On the one hand one aspect is being near ones home, on the other hand the expectations on a life as long as possible afterwards are of course of greater importance.

Hannover (Germany) for example, points out again and again a delightful 10-year-survining-rate of around 50% for double lung tranplantation (DLTx), which is more the 5-year-surviving-rate in other centers and in the ISHLT-register. On the other hand, the selection of patients is different from center to center. I just have communicated with a woman, who had been graded in Munich to be too good for a LTx, while in Hannover, however, she has been listed right away HU (high urgency?) due to frequent exacerbations.
Can you assume in Germany, that in case of a similar health status before LTx the chances at different centers are similar, or is the treatment, respectively the success critically different?
Yours sincerely and thank you for the answer,

Answer

Hello,
that is quite a number of questions, which do understandably interest all patients, who are facing a transplantation.

Life-expectancy after transplantation: it is not always justified to simply compare the data, as in some centers (to my knowledge also in Hannover, Germany) the data concerning life-expectancy are calculated with inclusion of re-transplantations. In case at such a center a further (or a second or third) re-transplantation is done much more generously as well, this does result of course in other numbers of life-expectancy compared to just stating the time of fuctioning of the transplant (like in the international register, that is conducted in the USA).

Listing of transplantations: indeed, the European and the American lung-transplantation centers agreed on common criteria, when a listing should happen (and when not yet and when not any more). However, this process is always a bit slow and can not immediately react to the latest findings, it sometimes needs two years until they agree on new recommendations. In addition, in all "recommendations" there is still a bit of subjective estimation (on both sides, means at the patient and at the doctor or Tx-team). In Germany, the rules of urgency (HU = high urgency) are defined in a very tight frame at Eurotransplant. For HU, the patient has to be ventilated and on intensive care unit and really be in a critical condition, so that it appears implausible to me, that the rating at two centers differs so much. It is possible of course, that inbetween two appointments the condition has been changed considerably (critically) or that the information has not been given totally correctly.

Chances equal? It is uncontroversial that experience counts and a certain minimal size of the Tx-center is an important condition for achieving good results. If it is sensible to draw the line of size further and further, meaning "bigger is better" is doubtful to me: exceeding a certain size, the individual care is decreasing and this has possibly a negative influence on the results.
You should take into account, that in spite of all statistical data and probability, each single human being will have an individual course and that the importance of different influencing factors has to be valued individually by each human being.
I wish you all the best and much luck for the important decisions, being in front of you.
Prof. Dr. TOF Wagner

10.11.2008