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TRANSPLANT STUDY PUTS UTAH SURVIVAL BELOW U.S. NORM

Patients receiving organ transplants in Utah have slightly lower survival rates than expected, a new federal study says.

Still, such rates at Utah hospitals performing transplants - LDS, the University of Utah and the Veterans Affairs Medical Center - are within broad ranges considered acceptable. And the hospitals complained the new study did not include some data that would have improved their marks.That came as the Health Resources and Services Administration released Tuesday the first-ever, nationwide hospital-by-hospital evaluation of organ transplant programs. It covered transplants performed between Oct. 1, 1987, and Dec. 31, 1989.

It said the chance of surviving one year after a transplant does not appear to depend greatly on where the surgery is performed because only 9 percent of the country's 531 transplant programs had death rates higher than expected for the types of patients they serve.

Coincidentally, a total of 9 percent of sites - but not necessarily the same ones - had organ survival rates lower than expected.

Most programs in Utah fell among that 9 percent of lower-than-expected patient or organ survival rates.

Only heart transplants performed at LDS Hospital had higher-than-expected survival rates for both patients and transplanted organs themselves. Organ-transplant rates can be different - and are often lower - than patient-survival rates because of repeat transplants and other life-preserving measures such as kidney dialysis.

Having the mixed success of higher-than-normal patient survival rates but lower-than-normal organ survival rates were pancreas transplants at LDS Hospital and kidney transplants at the University of Utah.

And having both lower-than-normal survival rates for organs and patients were kidney and liver transplants at LDS Hospital; heart, heart-lung and lung transplants at the University of Utah; and heart transplants at the VA Medical Center.

Even with lower-than-normal scores, the hospitals still fit within broad ranges considered acceptable according to complicated statistical tests. The study also warned that hospitals with low scores "are not necessarily of lesser quality" because low marks "may be caused by risk factors not included in the calculation of expected rates."

Utah hospitals wrote responses - which were included in the massive, six-volume study - saying some key data may have been overlooked that would have given their programs higher marks.

For example, the University of Utah noted that it changed immunosuppressive protocols for kidney transplant patients in the middle of the period studied that lowered the chances of organ rejection or failure.

After the changes on Feb. 10, 1989, the program had no deaths in the study period (it had two before) - and the one-year organ survival rate increased from 65.1 percent before the change to 91.2 percent after it.

The hospital wrote, "This experience since Feb. 10, 1989, more accurately reflects the current (transplant) survival expectations at our institution."

Similarly, LDS Hospital noted the number of diabetes patients receiving kidney transplants there is 15 percent higher than average, a statistic that could bring lower survival rates because such patients do not do well in the long run as a result of diabetic complications to the heart and brain.

Another example of complaints about the study is that the three Utah hospitals - which comprise the Utah Transplantation Affiliated Hospitals (UTAH), and work together on heart transplants - also said the period chosen for the study gave them lower scores on heart transplants than they feel they deserve.

They noted the UTAH doctors had performed 419 heart transplants between 1985 and Dec. 2, 1991 at the three hospitals, and the overall one- and six-year patient survival rates were 88 percent and 79 percent respectively.

However, the worst year in the UTAH doctors' history was 1988 when it's one-year survival rate was just 76 percent - and it happened to fall during the period studied by the federal government, giving a perception it is less successful than it is.

The new report was mandated by Congress in 1990. The federal government especially cares about the quality and cost of transplant programs because, for example, Medicare or Medicaid pays for more than 90 percent of the kidney transplants performed.

Federal health officials said the study showed the programs throughout the country are highly successful with one-year patient survival rates of 92.9 percent for kidney transplants, 88.7 percent for pancreas, 82.1 percent for heart, 74.4 percent for liver, 53.3 percent for heart-lung and 53.9 percent for lung.

Transplanted organs: Success rate

October 1987-December 1989

1-year Expected

Number Survival Survival

Number Failed Rate Rate

LDS Hospital

Heart 49 6 87.8 81.7

Kidney 155 34 77.5 81.3

Liver 30 16 46.7 65.1

Pancreas 21 7 65.0 72.4

University of Utah

Heart 63 13 79.4 82.5

Heart-Lung 1 1 0.0 33.6

Kidney 94 25 73.4 79.5

Lung 1 1 0.0 32.3

VA Medical Center

Heart 50 13 74.0 81.6