BY JOHN HOPKINS
The Cincinnati Enquirer
At least 29 organ transplant recipients from Children's and University hospitals since the 1960s have been among record-setters for length of survival -- and a national report published Tuesday had more good news about survival rates.
A study in today's Journal of the American Medical Association (JAMA) found that organ recipients are surviving longer than they did 10 years ago.
According to the JAMA article, Dr. Hung-Mo Lin of the United Network of Organ Sharing (UNOS) and colleagues studied 97,587 solid-organ transplants performed from January 1988 to April 1994 to report the short- and long-term survival rates of transplanted organs and organ recipients for all solid-organ transplants in the United States.
The study found that 98 percent of transplanted organs and 96 percent of organ recipients survived short-term (three months) for all organs. The long-term survival for both the transplanted organ and the organ recipients exceeded 91 percent for all organs, according to researchers.
It is the first report from UNOS to use national data to evaluate separately short- and long-term risk factors, the researchers said.
Locally, a 7-year-old who received a kidney in 1966 at Children's Hospital is now listed as one of the nation's longest survivors by World Transplant Records, a national list of record-setting transplant accomplishments. A former Cincinnati police officer has lived for 31 years with a transplanted kidney from University Hospital.
But a related article in JAMA also pointed to a number of barriers hampering access of minorities, women and poor people to kidney transplants. Correcting "substantial differences in access" is one of the challenges facing transplant providers.
The overall progress of organ transplants mirrors what is taking place in the Tristate, said Dr. Roy First, medical director of kidney transplantation at University Hospital and professor of medicine at the University of Cincinnati College of Medicine.
"We have a lot of notable records, but certainly the transplant success, as the (JAMA) article suggests, has improved over the last decade," said Dr. First, who has been with the University Hospital transplant program since 1973.
"With the drugs available today, there have been slow and steady improvements in overall outcomes," he said.
Dr. Doug Hanto, professor of surgery and director of the adult liver transplant program at University Hospital, said his program has also shown a steady climb in the liver patient survival rate. The one-year survival rate in 1995 was 80 percent, he said. It was 82 percent in 1996. Last year, it was at 90 percent for liver patients. "My guess is that if you looked at our numbers, they're better than the national average," said Dr. Hanto.
For the Health Alliance of Greater Cincinnati, the one-year heart survival rate was 80 percent in 1995 and 94 percent in 1996. Kidney survival rates were 93 percent in 1995 and 95 percent in 1996. The Health Alliance includes Christ, University, Jewish, St. Luke and Fort Hamilton-Hughes Memorial hospitals.
A few of the reasons for the progress include improvements in suppression and surgical techniques; better patient selection; and the ability to treat certain kinds of infections, said Dr. Hanto. Survival rates continue to climb while transplant providers are treating more seriously ill patients than ever before.
The news was not all rose-colored. In another report, Dr. G. Caleb Alexander and Ashwini R. Sehgal of Case Western Reserve University in Cleveland found substantial differences in kidney access for certain groups. But the doctors said their research cannot explain why certain steps in the transplant process serve as barriers. Their study was of 7,125 patients beginning long-term dialysis between January 1993 and December 1996 in Indiana, Kentucky and Ohio. Four steps in the process have served as barriers to blacks, women and the poor.
They include:
- Being declared medically suitable for transplantation.
- Expressing interest in receiving a transplant.
- Completing the pre-transplantation workup.
- Moving up a waiting list and receiving a transplant.
The researchers urged transplant providers to ensure that transplant candidates are identified equitably and then assisted through the process as expeditiously as possible.
"The study exposes just how discriminatory the U.S. health care system can be, even for those with health insurance," said Dr. Peter Lurie, a medical researcher at Public Citizens Health Research Group.
"These shameful biases in American medicine must be eliminated by, for example, using case managers to help African-Americans, women and the poor navigate the system more efficiently."
