A survey of clinical practice of lung transplantation in North America

Objectives: The clinical practice of lung transplantation (LT) varies widely among transplant centers. The objective of this study was to determine the practice patterns of North American lung transplant programs in specific areas that are considered controversial by most lung transplant practitioners. Methods: The Transplant/Immunology Network of the American College of Chest Physicians (ACCP) designed a survey and distributed it through the ACCP using a Web-based survey tool. The survey was divided into the following two sections: (1) patient selection issues; and (2) posttransplant management. Additional questions were asked about graft preservation, retransplantation, and living donor operations. A single 64-question survey was sent to each lung transplant program in the United Sates registered in the United Network of Organ Sharing database as of September 2001 and to each of the five active Canadian programs. Results: The survey was conducted in September and October 2002. Fifty of 65 active centers completed the survey, for a response rate of 77%. The data are presented in graphic format as a percentage of respondents. Conclusion: This survey provides a large, time-sensitive database summarizing the clinical practice of LT in North America. In general, the survey responses demonstrated a remarkable degree of consistency around patient selection criteria, but much greater variance in posttransplant management of lung transplant recipients. These findings may reflect the fact that a published selection criteria guideline exists, but no similar documents have been designed for postoperative management. Hopefully, postoperative areas with widely divergent approaches to management will foster future collaborative studies aimed at identifying the most appropriate practices.