RESUMEN
OBJECTIVE: On November 24, 2017, Organ Procurement and Transplantation Network implemented a change to lung allocation replacing donor service area with a 250 nautical mile radius around donor hospitals. We sought to evaluate the experience of a small to medium size center following implementation. METHODS: Patients (47 pre and 54 post) undergoing lung transplantation were identified from institutional database from January 2016 to October 2019. Detailed chart review and analysis of institutional cost data was performed. Univariate analysis was performed to compare eras. RESULTS: Similar short-term mortality and primary graft dysfunction were observed between groups. Decreased local donation (68% vs 6%; P < .001), increased travel distance (145 vs 235 miles; P = .004), travel cost ($8626 vs $14,482; P < .001), and total procurement cost ($60,852 vs $69,052; P = .001) were observed postimplementation. We also document an increase in waitlist mortality postimplementation (6.9 vs 31.6 per 100 patient-years; P < .001). CONCLUSIONS: Following implementation of the new allocation policy in a small to medium size center, several changes were in accordance with policy intention. However, concerning shifts emerged, including increased waitlist mortality and resource utilization. Continued close monitoring of transplant centers stratified by size and location are paramount to maintaining global availability of lung transplantation to all Americans regardless of geographic residence or socioeconomic status.
Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Enfermedades Pulmonares , Trasplante de Pulmón , Asignación de Recursos , Obtención de Tejidos y Órganos , Listas de Espera/mortalidad , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Rechazo de Injerto/epidemiología , Hospitales de Bajo Volumen/economía , Hospitales de Bajo Volumen/estadística & datos numéricos , Humanos , Enfermedades Pulmonares/clasificación , Enfermedades Pulmonares/mortalidad , Enfermedades Pulmonares/cirugía , Trasplante de Pulmón/métodos , Trasplante de Pulmón/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Mortalidad , Evaluación de Necesidades , Innovación Organizacional , Asignación de Recursos/métodos , Asignación de Recursos/organización & administración , Asignación de Recursos/tendencias , Donantes de Tejidos , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/legislación & jurisprudencia , Obtención de Tejidos y Órganos/tendencias , Estados Unidos/epidemiologíaRESUMEN
Benign metastasizing leiomyomatosis (BML) is a rare cause of pulmonary lesions found in reproductive age women who have undergone a hysterectomy for uterine leiomyoma. Given the relative rarity of the disease, the management of these lesions varies from surgical (oopherectomy) or medical antiestrogen hormonal therapy to clinical observation and survelliance. The disease generally presents asymptomatically with multiple, well-defined pulmonary nodules discovered incidentally on imaging. We report an atypical presentation of a 46-year-old woman with incidentally found bilateral pulmonary cavitating nodules and cysts, concerning for lymphangioleiomyomatosis (LAM), who was ultimately diagnosed with BML.