Variability in Lung Transplant Clinical Practices in Canada: Results of a National Survey

Background: Lung transplant outcomes remain inferior to other solid organ transplants, but there is substantial heterogeneity. Some of this may relate to variations in clinical practice, but the degree to which this variability exists in Canada is not known. We sought to quantify the average practice and the variance among Canadian lung transplant physicians and surgeons via a national survey. Methods: We conducted a digital survey of all physicians and surgeons in all Canadian lung transplant centers, including surgical centers (which perform transplants and provide care pre- and posttransplant) and nonsurgical centers (which provide care pre- and posttransplant). We reported overall averages and results stratified by center. Variability across centers was expressed as Pearson chi-square tests or ANOVA, whereas within-center variability was expressed as percentages and interquartile ranges. Results: We identified 55 clinicians across Canada, of whom 44 (80%) completed the survey, including 31 physicians and 13 surgeons. Respondents were predominantly men (64%), of age 40-49 y (36%), and in practice for 5-15 y (47%). We found the most substantial variability between centers in infection prophylaxis (63%), immunosuppression/rejection management (59%), surgical and perioperative care, and candidate selection. Significant practice variability was also noted within centers. Conclusions: This is the first portrait of average Canadian lung transplant practice and how these differ within and between centers. These differences may affect access to transplantation as well as posttransplant outcomes, and discussions about care standardization based on the best available evidence via existing national bodies would be worthwhile.