Top

Published in:

Open Access 01-12-2014 | Research

Influence on ICU course, outcome and costs for lung transplantation after implementation of the new Swiss transplantation law

Authors: Stephanie Klinzing, Giovanna Brandi, Dimitri A Raptis, Urs Wenger, Denise Weber, Paul A Stehberger, Ilhan Inci, Markus Béchir

Published in: Transplantation Research | Issue 1/2014

Abstract

Background

The Swiss organ allocation system for donor lungs was implemented on 1 July 2007. The effects of this implementation on patient selection, intensive care unit course, outcomes and intensive care costs are unknown.

Methods

The first 37 consecutive lung transplant recipients following the implementation of the new act were compared with the previous 42 lung transplant recipients.

Results

Following implementation of the new law, baseline characteristics and cumulative one-year patient survival were comparable in both groups (88.1% vs 83.8%, P = 0.58). The costs for each case increased by 35,000 euros after adoption of the new law. Stratifying patients after implementation of the law according to urgency status shows that urgent patients required longer mechanical ventilation (P = 0.04), a longer ICU stay (P = 0.045) and a longer hospital stay (P = 0.04) and ICU costs (median 64,050 euros) were higher compared to regular patients.

Conclusion

The new transplantation law has increased ICU costs with the implementation of the Swiss organ allocation system. Patients listed as ‘urgent’ contribute significantly to the increase in ICU costs.

Lynch JP, Saggar R, Weigt SS, Ross DJ, Belperio JA: Overview of lung transplantation and criteria for selection of candidates. Semin Respir Crit Care Med. 2006, 27 (5): 441-469. 10.1055/s-2006-954604.CrossRefPubMed

Reitz BA, Wallwork JL, Hunt SA, Pennock JL, Billingham ME, Oyer PE, Stinson EB, Shumway NE: Heart-lung transplantation: successful therapy for patients with pulmonary vascular disease. N Engl J Med. 1982, 306 (10): 557-564. 10.1056/NEJM198203113061001.CrossRefPubMed

Shennib H, Noirclerc M, Ernst P, Metras D, Mulder DS, Giudicelli R, Lebel F, Dumon JF: Double-lung transplantation for cystic fibrosis. The cystic fibrosis transplant study group. Ann Thorac Surg. 1992, 54 (1): 27-31. 10.1016/0003-4975(92)91135-V. Discussion 31–32CrossRefPubMed

Christie JD, Edwards LB, Kucheryavaya AY, Benden C, Dobbels F, Kirk R, Rahmel AO, Stehlik J, Hertz MI: The Registry of the International Society for Heart and Lung Transplantation: twenty-eighth adult lung and heart-lung transplant report 2011. J Heart Lung Transplant. 2011, 30 (10): 1104-1122. 10.1016/j.healun.2011.08.004.CrossRefPubMed

Dorent R, Lamy FX, Cantrelle C: The role of the French Agence de la biomedecine in lung transplantation. Rev Pneumol Clin. 2010, 67 (1): 57-63. 10.1016/j.pneumo.2010.12.008.CrossRefPubMed

Egan TM, Murray S, Bustami RT, Shearon TH, McCullough KP, Edwards LB, Coke MA, Garrity ER, Sweet SC, Heiney DA, Grover FL: Development of the new lung allocation system in the United States. Am J Transplant. 2006, 6 (5 Pt 2): 1212-1227.CrossRefPubMed

Smits JM, Nossent GD, de Vries E, Rahmel A, Meiser B, Strueber M, Gottlieb J: Evaluation of the lung allocation score in highly urgent and urgent lung transplant candidates in Eurotransplant. J Heart Lung Transplant. 2011, 30 (1): 22-28. 10.1016/j.healun.2010.08.006.CrossRefPubMed

Swisstransplant, Laws and Regulations. [http://www.swisstransplant.org]

Krueger T, Berutto C, Aubert JD: Challenges in lung transplantation. Swiss Med Wkly. 2011, 141: w13292-PubMed

10.

Denlinger CE, Meyers BF: Update on lung transplantation for emphysema. Thorac Surg Clin. 2009, 19 (2): 275-283. 10.1016/j.thorsurg.2009.03.001.CrossRefPubMed

11.

Oberkofler CE, Dutkowski P, Stocker R, Schuepbach RA, Stover JF, Clavien PA, Béchir M: Model of end stage liver disease (MELD) score greater than 23 predicts length of stay in the ICU but not mortality in liver transplant recipients. Crit Care. 2010, 14 (3): R117-10.1186/cc9068.PubMedCentralCrossRefPubMed

12.

Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery J-L, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, Gomez-Sanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, Simonneau G: Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2009, 30 (20): 2493-2537.CrossRefPubMed

13.

Arnaoutakis GJ, Allen JG, Merlo CA, Sullivan BE, Baumgartner WA, Conte JV, Shah AS: Impact of the lung allocation score on resource utilization after lung transplantation in the United States. J Heart Lung Transplant. 2011, 30 (1): 14-21. 10.1016/j.healun.2010.06.018.PubMedCentralCrossRefPubMed

14.

Uehlinger NB, Beyeler F, Weiss J, Marti HP, Immer FF: Organ transplantation in Switzerland: impact of the new transplant law on cold ischaemia time and organ transports. Swiss Med Wkly. 2010, 140 (15–16): 222-227.PubMed

15.

Vasiliadis HM, Collet JP, Penrod JR, Ferraro P, Poirier C: A cost-effectiveness and cost-utility study of lung transplantation. J Heart Lung Transplant. 2005, 24 (9): 1275-1283. 10.1016/j.healun.2004.10.012.CrossRefPubMed

16.

van Enckevort PJ, Koopmanschap MA, Tenvergert EM, Geertsma A, van der Bij W, de Boer WJ, Rutten FF: Lifetime costs of lung transplantation: estimation of incremental costs. Health Econ. 1997, 6 (5): 479-489. 10.1002/(SICI)1099-1050(199709)6:5<479::AID-HEC287>3.0.CO;2-V.CrossRefPubMed

17.

Levy AR, Sobolev B, James D, Barrable W, Clarke-Richardson P, Sullivan SD, Keown PA, Chung S, Straatman L, Levy RD: The costs of change: direct medical costs of solid organ transplantation in British Columbia, Canada, 1995–2003. Value Health. 2009, 12 (2): 282-292. 10.1111/j.1524-4733.2008.00445.x.CrossRefPubMed

18.

Russo MJ, Iribarne A, Hong KN, Davies RR, Xydas S, Takayama H, Ibrahimiye A, Gelijns AC, Bacchetta MD, D'Ovidio F, Arcasoy S, Sonett JR: High lung allocation score is associated with increased morbidity and mortality following transplantation. Chest. 2010, 137 (3): 651-657. 10.1378/chest.09-0319.PubMedCentralCrossRefPubMed

19.

Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D, CESAR trial collaboration: Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009, 374 (9698): 1351-1363. 10.1016/S0140-6736(09)61069-2.CrossRefPubMed

20.

Lang G, Taghavi S, Aigner C, Rényi-Vámos F, Jaksch P, Augustin V, Nagayama K, Ghanim B, Klepetko W: Primary lung transplantation after bridge with extracorporeal membrane oxygenation: a plea for a shift in our paradigms for indications. Transplantation. 2012, 93 (7): 729-736. 10.1097/TP.0b013e318246f8e1.CrossRefPubMed

21.

Javidfar J, Brodie D, Iribarne A, Jurado J, Lavelle M, Brenner K, Arcasoy S, Sonett J, Bacchetta M: Extracorporeal membrane oxygenation as a bridge to lung transplantation and recovery. J Thorac Cardiovasc Surg. 2012

22.

Bittner HB, Lehmann S, Rastan A, Garbade J, Binner C, Mohr FW, Barten MJ: Outcome of extracorporeal membrane oxygenation as a bridge to lung transplantation and graft recovery. Ann Thorac Surg. 2012

23.

Broome M, Palmér K, Scherstén H, Frenckner B, Nilsson F: Prolonged extracorporeal membrane oxygenation and circulatory support as bridge to lung transplant. Ann Thorac Surg. 2008, 86 (4): 1357-1360. 10.1016/j.athoracsur.2008.03.053.CrossRefPubMed

24.

Garcia JP, Iacono A, Kon ZN, Griffith BP: Ambulatory extracorporeal membrane oxygenation: a new approach for bridge-to-lung transplantation. J Thorac Cardiovasc Surg. 2010, 139 (6): e137-e139. 10.1016/j.jtcvs.2009.12.021.CrossRefPubMed

25.

Boussaud V, Mal H, Trinquart L, Thabut G, Danner-Boucher I, Dromer C, Raymond CS, Reynaud-Gaubert M, Kessler R, Philit F, Dorent R, Stern M: One-year experience with high-emergency lung transplantation in France. Transplantation. 2012, 93 (10): 1058-1063. 10.1097/TP.0b013e31824d7079.CrossRefPubMed

Title: Influence on ICU course, outcome and costs for lung transplantation after implementation of the new Swiss transplantation law
Authors: Stephanie Klinzing
Giovanna Brandi
Dimitri A Raptis
Urs Wenger
Denise Weber
Paul A Stehberger
Ilhan Inci
Markus Béchir
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Transplantation Research / Issue 1/2014
Electronic ISSN: 2047-1440
DOI: https://doi.org/10.1186/2047-1440-3-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Influence on ICU course, outcome and costs for lung transplantation after implementation of the new Swiss transplantation law

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2014

Effect of left atrial and ventricular abnormalities on renal transplant recipient outcome—a single-center study

Cascade plasmapheresis (CP) as a preconditioning regime in ABO-incompatible live related donor liver transplants (ABOi-LDLT)

A randomized controlled trial of daclizumab versus anti-thymocyte globulin induction for heart transplantation

Active video gaming in patients with renal transplant: a pilot study

The feasibility and applications of non-invasive cardiac output monitoring, thromboelastography and transit-time flow measurement in living-related renal transplantation surgery: results of a prospective pilot observational study

Volume and outcome relation in German liver transplant centers: what lessons can be learned?