What is the success rate and what does that mean?
This is a subject that is often dominant in the mind of the transplant candidate early in the process of consideration. It generally loses its importance as the disease propelling the need for a transplant escalates. At some point, even a 10% chance at survival looks like a good bet--it's a simple matter of survival.
Which is not to say that success rates in and of themselves are not important as a relative gauge of the skill and ability of a transplant center compared to another, or as a general scale on which to properly set the patient's expectations.
Then again, there are success rates and there are success rates. A common rule of thumb that is quoted almost robotically by doctors and transplant coordinators (when asked the question for the two-thousandth time), is that 75% of lung transplant patients survive the first year and another 5% fail each year after that. This rough estimate can and should be further analyzed and/or qualified, as follows:
1. There is the success rate of the transplant procedure itself. Lung transplants have been performed since roughly the mid-80's, after Dr. Joel S. Cooper showed while at the University of Toronto how it could be done. Some opinions have it that a slip-fit approach to graft construction made the difference, while others credit anti-rejection drugs. Regardless, some 15 years later, lung transplants are approaching the kind of success rates of other mid-body solid organs, i.e., 75-85% after a year or two.
2. Averages such as the rule-of-thumb quoted above encompass all transplant patients with all types of disease, at all eligible ages, referred early and late, with and without other complications, at all transplant centers good and bad, and transplanted with donor organs fresh and not-so-fresh. There is a lot of variability implicit in this as in any average, but in a subject as fearsome as this, it can be needlessly damaging. The fact is you can probably count yourself as better in some categories than others, so if there is a range, adjust your expectations accordingly.
3. Then there is the published success rate of the transplant center itself. This number is available at UNOS (www.unos.org). This number--or these numbers, as you can look at the success rates of many centers and compare them, which is kind of the point--may or may not be current. UNOS has been terrible about updating their numbers. Most date from 1994, which in lung transplant years is almost ancient. They do, however give a fairly good relative indication, since as the number of transplants done per year at any one center rarely tops one hundred, adjustments in this rate are slow to be reflected. And, as with many large imponderable institutions, things tend to happen slowly anyway. Such is the nature of bigness.
4. Lastly there is the role played by the transplantee himself (or herself) in terms of adherence to medications, checkups, reporting of symptoms real and imagined, and so forth. This can greatly influence the success of the transplant.
So how at the end of all of this do you determine what YOUR chances are? As explained above, it usually depends on where in the disease process you are. Early on, you look at the lowest numbers, and by the time you realize you are very, very sick, you look at the high numbers. It helps to be optimistic.
Still, to get the best results you must exercise due dilligence--do the research, select the best program, do everything right, discount the risks and take the high road. Essentially, at the end of the day, you pray that you get into a transplant program and then you pray that you get the call. After that, whatever happens, happens.
To me, the whole issue of what to do where and why is kind of summed up by a joke told by Gary Shandling (who plays Larry Sanders on HBO):
"I'm very selective about dating. I only go out with girls that let me."