Relationship Between Change in Heart Transplant Volume and Outcomes: A National Analysis |
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| Institution: | 1. Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;2. Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;1. U.O.C. Cardiologia Clinica e Riabilitativa, P.O. San Filippo Neri Hospital-ASL, Rome, Italy;2. U.O.C. Pronto Soccorso e Medicna d''Urgenza, PO San Filippo Neri Hospital-ASL, Rome, Italy;3. Cardiologia 2, ASST Grande Ospedale Metropolitano Niguarda Cà Granda, Milan, Italy;4. U.O.C. Medicina Interna, P.O. San Filippo Neri Hospital-ASL, Rome, Italy;1. The George Institute for Global Health and University of New South Wales, Sydney, Australia;2. Sydney School of Public Health, University of Sydney, Sydney, Australia;3. Department of Renal Medicine, St George Hospital, Sydney, Australia;4. University Health Network, Toronto, Canada;5. Faculty of Medicine and Health, University of Sydney, Sydney, Australia;6. Sydney Translational Imaging Laboratory, Charles Perkins Centre, University of Sydney, Sydney, Australia;7. Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia;8. Specialist Magnetic Resonance Imaging, Newtown, Australia;9. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia;10. Peking University People''s Hospital, Beijing, China;11. Renal Department, Sichuan Provincial People''s Hospital, Chengdu, China;12. Sunshine Coast University Hospital, Birtinya, Australia;13. School of Health and Sport Sciences, University of the Sunshine Coast, Australia;14. North Shore Hospital, Auckland, New Zealand;15. Department of Medicine, University of Auckland, Auckland, New Zealand;16. Renal Unit, Concord Repatriation General Hospital, Sydney, Australia;1. University Paris-Saclay, Le Kremlin-Bicêtre, France;2. AP-HP, Service de Cardiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France;3. Service de Cardiologie, ELSAN–Polyclinique de Poitiers, Poitiers, France;4. AP-HP, Service de Santé Publique et Epidémiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France. CESP, INSERM, University Paris-Saclay, UVSQ, Université Paris-Saclay, Paris, France;5. AP-HP, Henry Mondor Hospital; Department of Cardiology; Heart Failure and Amyloidosis Unit, INSERM/UPEC: U955, GRC Amyloid Research Institute, Créteil, France;6. Department of Thoracic Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France;7. AP-HP, Service de physiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France;1. Department of Medicine, Division of Cardiovascular Diseases, University of Mississippi Medical Center, Jackson, MS;2. Cardiovascular Division, Brigham and Women''s Hospital and Harvard Medical School, Boston, MA;3. Department of Medicine, Cook County Health Sciences, Chicago, IL |
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| Abstract: | IntroductionAlthough volume–outcome relationships in transplantation have been well-defined, the effects of large changes in center volume are less well understood. The purpose of the current study was to examine the impact of changes in center volume on outcomes after heart transplantation.MethodsRetrospective analysis was performed of adult patients undergoing heart transplant between 2000 and 2017 identified in the United Network for Organ Sharing database. Exclusions included annual volume <10. Patients were grouped according to percentage change in center volume from the previous year. Multivariable Cox regression models were adjusted for the significant preoperative variance identified on univariate analyses.ResultsOf the 29,851 transplants during the study period, 64% were at centers with stable volume (±25% annual change), whereas 10% were performed at contracting (−25% change or more) and 26% were performed at growing (+25% change or more) centers. Average volume was lower with contracting centers compared with stable or growing programs (21 vs 36, P< .001). Thirty-day mortality was greater in decreasing centers (6% vs 4%, P < .001), with more acute rejection treatments at 1y (27% vs 24% P < .001). The adjusted risk of mortality among contracting centers was 1.25 (1.07–1.46], P= .004), whereas growing centers had unaffected risk (0.90 0.79–1.02], P= .103). Causes of death were similar between groups.ConclusionsRapid growth of transplant center volume has occurred at select centers in the United States without decrement in programmatic outcomes. Decreasing center volume has been associated with poorer outcomes, although the causative nature of this relationship requires further investigation. |
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