C16-07 Lung Transplant Recipients Enrolled in a Nationally Integrated Health System Have Higher Survival Compared With Matched Controls

Abstract Rationale Five-year survival following lung transplantation (LTx) is approximately 10-15% higher in Canada and Europe than the US. The reasons for this may be related to aspects of care delivery such as gaps in primary care or prescription drug coverage (e.g. immunosuppressive medications). The Veteran Affairs (VA) LTx program is the only fully integrated, need-blind, program in the US. This care delivery model may mitigate some of these care gaps and lead to better outcomes. We hypothesized that post-LTx survival is higher amongst individuals who get their care in an integrated health system (VA) compared to propensity matched controls. Methods We analyzed all US LTx recipients from 2009-2019 with three-years follow-up through the Scientific Registry of Transplant Recipients (SRTR) database and VA datasets. The index date was the LTx date. We categorized recipients into three groups: Group 1 (n = 164) - LTx at a VA center with all pre- and post-LTx care within the VA; Group 2 (n = 1,126) - LTx at a non-VA center and receives non-LTx care at the VA (dual coverage); and Group 3 (n = 17,320) - receives all care outside the VA. We calculated propensity scores using a one-to-many, nearest neighbor approach based on 17 variables such as age, sex, lung allocation score (LAS), LTx center size, and diagnosis. Our primary analysis tested for differences in post-LTx survival between Groups 1 and 3 using Cox PH regression and we performed a sensitivity analysis comparing Groups 1 and 2. Results Subject characteristics at the time of LTx are shown in the Table. Group 1 had fewer women and had a slightly lower LAS compared with Group 3. Three-year unadjusted survival was higher in Group 1 (84%) vs. Group 2 (68%) or Group 3 (72%) (Panel A). We achieved balance of propensity matched patients in Group 1 vs. 3 with all standardized differences 0.12. Group 1 had a higher 3-year survival compared to Group 3 in our primary analysis HR 0.60 (95% CI 0.44-0.82), p-value=0.001 (Panel B). In the sensitivity analysis, we detected a survival benefit in Group 1 vs. 2 HR 0.50 (95% CI 0.35-0.73), p-value0.001 (Panel C). Conclusions Our findings suggest post-LTx survival is higher in patients cared for within an integrated healthcare system compared with a matched cohort of recipients in non-integrated systems. Future studies are needed to determine what aspects of post-transplant care (e.g. drug coverage, density of follow-up care) might be contributing to these potential differences. This abstract is funded by: None