Impact of Center Heart Transplant Volume on One-Year Survival or Retransplantation: A 2006 to 2016 UNOS Based Analysis

M. Shah, S. Patel, O. Saeed, P. Pirlamarla, S. Vukelic, S. Forest, D. Goldstein, R. Alvarez, U. P. Jorde

Research output: Contribution to journalArticle

Abstract

PURPOSE: Previous studies have demonstrated a correlation between increasing center volume and improved post heart transplant (HTx) survival. We performed a contemporary analysis to evaluate this relationship. METHODS: The UNOS database was analyzed to include adult (≥18 years) HTx recipients from years 2006 to 2016. Each center had to perform >65 transplants to be included. Centers were categorized based on annual transplant volume: 6-15, 16-25, 26- 39 and ≥40. Primary endpoint was one-year mortality or retransplantation. Survival analysis was performed using Kaplan-Meier method. Adjusted analysis were performed using Cox-regression modeling. RESULTS: Among 17,853 HTx recipients, distribution of patients was 32.1%, 30.8%, 14.5% and 22.6% in the order of increasing center Htx volume, respectively. Median recipient age was 56 years (IQR 47-63) and 75.5% were male. Primary endpoint of one-year mortality or retransplantation was similar across the centers irrespective of transplant volume (6-15/yr: 10.4%, 16-25/yr: 9.5%, 26-39/yr: 11.1%, ≥40/yr: 9.7%; χ2 p=0.10 and Log-rank p=0.11) as noted in figure 1. When adjusted for recipient and donor risk factors, the Cox-regression analysis showed that centers with ≥40 Htx/yr had a lower rate of one-year mortality/retransplantation (HR 0.86; 95% CI 0.75-0.98; p=0.029) compared to patients at centers with volume 6-15/yr. The two remaining categories 16-25/yr (HR 0.94; p=0.31) and 26-39/yr (HR 1.06; p=0.43) showed no difference in primary endpoint when compared to the lowest volume category (6-15 /yr). CONCLUSION: There was no difference in baseline rate of mortality or retransplantation at 1-year among Htx centers irrespective of volume. Among all categories, only centers with ≥40 Htx/yr had an improved risk adjusted primary endpoint compared to the centers with lowest volume. The correlation between increasing center volume and improved survival appears to have weakened in this updated analysis among US transplant centers.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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