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I've run various different bushing and bearing turbos and I have to say even at altitude the 38R is pretty solid. Still running it. Driving between 8000-11000ft it still makes 26psi with Rosewood Stage 2's.
I think it depends on what you use the truck for and what you want out of it. What supporting mods do you have? In other words a new Turbo is not gonna buy you a lot without some supporting mods and $$$
I'm running a Van Turbo with a WW2 that I have $400 bucks into it with rebuild (see my sig, blah, blah, blah). It's more than my stock injectors can handle. I tow with this setup and the Van Turbo opens up the top end and drops EGT's to the point that I have a hard time getting it over 1200 degrees no matter what tune I'm in or how much I'm towing.