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Center volume and post-transplant survival among adults with congenital heart disease
- Source :
- The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 37(11)
- Publication Year :
- 2018
-
Abstract
- BACKGROUND The number of adult congenital heart disease (ACHD) patients requiring heart transplantation (HT) continues to grow, and if they survive the first year after transplant, their long-term survival is at least equivalent to non-ACHD patients. The 1-year survival of ACHD patients with HT remains lower than non-ACHD patients. We evaluated the affect of transplant center volume on 1-year survival of ACHD patients. We analyzed United Network of Organ Sharing patients (age ≥18 years) who underwent their first orthotopic HT between January 1, 2000, and December 31, 2015, to assess the association between transplant center volume and 1-year survival of ACHD patients. RESULTS We identified 827 ACHD patients at 113 centers who underwent HT during the study period. The average age of the recipients and donors was 36 ± 13 years (60% men and 84% Caucasian) and 28 ± 11 (63% men and 66% Caucasian), respectively. Of the ACHD patients undergoing HT, 27% (n = 60) were done at low-volume centers, 30% (n = 10) were reported at high-volume centers, and the remaining (n = 43) were at medium-volume centers. A total of 96 patients died within 30 days, including 37 (16.7%) at low-volume, 37 (10.2%) at medium-volume, and 22 (9.0%) at high-volume centers (p = 0.019). The average unadjusted Kaplan-Meier 30-day survival at low-volume centers was 83% ± 2%, which was significantly lower than medium-volume (90% ± 1%) and high-volume (91% ± 2%) centers (log-rank p < 0.05). Within 1 year, 154 patients had died, including 56 (36.4%) at low-volume, 60 (38.9%) at medium-volume, and 38 (24.7%) at high-volume centers (p = 0.011). Average unadjusted Kaplan-Meier 1-year survival at low-volume centers was 75% ± 3%, which was significantly lower than medium-volume (83% ± 2%) and high-volume (84% ± 2%) centers (log-rank p < 0.05). CONCLUSIONS The 30-day and 1-year survival of ACHD patients undergoing HT is partly influenced by overall transplant center volume and, potentially, volume of ACHD HTs, with low-volume centers performing poorly relative to medium-volume and high-volume centers. The role of peri-operative care and multidisciplinary management in improving survival at low-volume centers required further investigations.
- Subjects :
- Pulmonary and Respiratory Medicine
Adult
Heart Defects, Congenital
Male
medicine.medical_specialty
Hospitals, Low-Volume
Heart disease
medicine.medical_treatment
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Risk Factors
Internal medicine
Medicine
Humans
030212 general & internal medicine
Heart transplantation
Heart Failure
Transplantation
business.industry
Middle Aged
medicine.disease
Post transplant
Center volume
Heart Transplantation
Surgery
Female
Cardiology and Cardiovascular Medicine
business
Tomography, X-Ray Computed
Hospitals, High-Volume
Follow-Up Studies
Subjects
Details
- ISSN :
- 15573117
- Volume :
- 37
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
- Accession number :
- edsair.doi.dedup.....053ef1fb528f1d64396437bc4b02cc00