In the more than 30 years since they were first performed, organ transplants have become highly successful procedures, with patients' survival rates for the most popular type--kidney transplants--as high as 93% one year after surgery, according to a major national study.
For transplants other than kidneys, the one-year survival rate for patients is nearly as encouraging: 88.7% for pancreas, 82.1% for heart, 74.4% for liver, 53.3% for heart-lung and 53.9% for lung, the study said.
The first hospital-by-hospital report on transplant survival also showed that the rates were similar among most transplant centers across the nation, a development described as "good news" for patients and their families, said Dr. Robert G. Harmon, administrator of the Health Resources and Services Administration, which released the report.
"Organ transplantation is truly one of the miracles of modern medicine (and one) where the United States is a world leader," Harmon said.
According to the report, mandated by Congress, patient survival rates in about 29,000 transplants performed at 252 hospitals across the country between Oct. 1, 1987, and Dec. 31, 1989, were similar when adjustments were made for various factors, including the recipients' age, sex, race and underlying condition, as well as the characteristics of donors.
The report listed survival rates at specific hospitals but did not rank them against one another because such comparisons would not be either accurate or fair, Harmon said.
"To rank them would be as inappropriate as ranking students after the first test," he said.
Instead, each hospital's actual survival rate for each kind of transplant procedure was compared to that same institution's "expected" survival rate. The expected survival rate is a number based on a combination of risk factors within that facility's patient population.
The report did not account for discrepancies between expected and actual survival rates.
In general, centers that performed a large number of transplants on high-risk patients had lower expected survival rates.
Officials said the information would be useful for future potential transplant recipients who wish to know more about an institution's programs and experience.
"For me, back in 1983, this would have been a godsend," said Dennis Rager, who received a new liver at UCLA Medical Center nine years ago and appeared at a press conference here. "It would have given me a tremendous amount of information."
Harmon also emphasized that the transplant success rate has intensified the nationwide shortage of organs. "The need for donors is still critical," he said, adding that some 28,000 Americans are awaiting organ transplants, while 2,000 are dying annually for lack of organs.
"In a way, we are victims of our own success," said Dr. Thomas Rosenthal, surgical director of the renal transplant program at UCLA Medical Center, which had survival rates in the report exceeding both the national average and the expected rate for that center. "The success rate has been one of the things that has almost created the organ shortage problem."
Kidney transplants have been performed for more than 30 years and "for the last 10 years they have been a routine part of care for patients with end-stage renal disease," he said. There are approximately 140,000 kidney transplant recipients in the United States, he said.
Furthermore, the results for heart and liver procedures are "astonishingly good, when you figure how far they have come in a short period of time," Rosenthal added. "In 1980, there were only two or three programs in the world doing liver transplants, with an average survival of 30%--so this shows you the leap of maturity in this field."
The report took into account such risk factors as whether the donor was living or dead, the recipient's overall health at the time of the operation, demographic information and whether the transplant was an initial attempt or a repeat. Other risk factors, such as diabetes, will be used in future reports, officials said.
While "this is the most scientific and valid analysis of transplant procedures to date, future studies including other important risk factors are expected to produce better measures of actual or expected survival rates," Harmon said.
In California, for example, UCLA's kidney transplant program, which involved 217 patients, showed an actual patient survival rate of 96.4% after one year, compared to the facility's expected survival rate of 93%. The rate of kidney failure also was less than expected. (The report included kidney-rate failure because recipients can live for a period of time even if the organ fails.)
At Cedars-Sinai Medical Center, where the procedure was performed on 80 patients, the actual survival rate was 92.5%, compared to the expected 92.2%, but the kidney failure rate was higher than expected. At USC Medical Center-Los Angeles County, where transplants were performed on 73 patients, the actual survival rate was 81.4%, compared to the expected 94.5%.
In liver transplants, UCLA, which performed 257 procedures, had an actual survival rate of 74.6%, compared to the expected 72.7%. Cedars-Sinai performed seven transplants, with an actual survival rate of 85.7%, compared to the expected 72.8%. UC San Francisco Medical Center, which performed 120 transplants, showed an actual survival rate of 82.9%, compared to the expected 75.9%.
For heart transplants, UCLA, which performed 91 procedures, had an actual survival rate of 88.9%, compared to the expected rate of 83.9%. Cedars-Sinai performed 17 procedures with an actual survival rate of 82.4%, compared to the expected rate of 85.3%.