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Variations in cardiac transplantation: comparisons between the United Kingdom and the United States
A C Anyanwu1, C A Rogers, A J Murday
1Surgical Epidemiology and Audit Unit, Royal College of Surgeons of England, London, United Kingdom.
Insights
Cardiac transplantation practices differ significantly between the UK and US, with the UK performing more transplants per center and utilizing living donor transplants more frequently. Further research is needed to understand these variations.
Area of Science:
- Cardiology
- Transplantation Medicine
- Health Services Research
Background:
- International variations in healthcare practices are common across medical specialties.
- This study specifically examines differences in cardiac transplantation between the United Kingdom (UK) and the United States (US).
Purpose of the Study:
- To compare cardiac transplantation practices in the UK and the US.
- To identify and quantify key differences in patient selection, procedures, and donor characteristics between the two countries.
Main Methods:
- Utilized data from the UK Cardiothoracic Transplant Audit (UK population: 620 listings, 463 transplants).
- Incorporated data from the United Network for Organ Sharing (UNOS) in the US (US population: 3946 listings, 4704 transplants).
- Compared transplant rates, patient demographics, pre-transplant support, donor characteristics, and transplant types.
Main Results:
- The UK performed significantly more transplants per center annually (34 vs. 14 in the US).
- The UK rarely listed patients over 65 (0.2% vs. 4.1% in US) or those with prior transplants (0.9% vs. 3.2% in US).
- Living donor (domino) transplants were common in the UK (7%) but rare in the US; heterotopic transplants were also more frequent in the UK.
Conclusions:
- Substantial differences in cardiac transplantation practices exist between the UK and US.
- Further investigation is warranted to explore the underlying reasons for these practice variations.
- The impact of these differences on transplant outcomes, as well as their ethical and economic implications, requires additional study.
Background:
International practice variations have been documented in various health care specialties. This study compares cardiac transplantation in the UK with practice in the US.
Methods:
UK data were from an ongoing multi-center prospective study, the UK Cardiothoracic Transplant Audit. The UK population comprised 620 listings and 463 transplants. US data were obtained from UNOS and comprised 3946 listings and 4704 transplants.
Results:
There was a mean of 14 transplants per center per year in the US compared with 34 in the UK. Notable differences in practice include rarity of listing in the UK of patients > 65 years (0.2% vs 4.1% in US) and patients with previous transplants (UK 0.9%, US 3.2%). Patients listed in the US were more likely to be on ventricular assist devices (odds ratio 8.0, 95% CI 3.0-21.7) or inotropes (odds ratio 4.9, 95% CI 3.7-6.4). Living donor (domino) transplants, although comprising 7% of transplants in the UK, are virtually non-existent in the US (1 domino in 4704 transplants). Heterotopic transplants were more common in the UK (4.4% vs 0.5%). Indications for transplant were similar (except retransplantation). The donor age was > 35 years in 43% of UK donors vs 33% of US donors.
Conclusion:
This study reveals substantial practice differences between the UK and US. Further studies are required to examine the reasons for these practice differences, the influence on transplant outcome, and their ethical and economic implications.