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The relation between experience and outcome in heart transplantation
G L Laffel1, A I Barnett, S Finkelstein
1Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
The New England Journal of Medicine
|October 22, 1992
Summary
Heart transplant center experience significantly impacts patient survival. Early transplants at a center had higher mortality, but experienced teams, particularly cardiologists, improved outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Health Policy
Background:
- Current organ transplantation policies in the US prioritize experienced centers and physicians.
- These policies may inadvertently restrict patient access to transplantation services.
- Validating these policies is crucial for equitable healthcare access.
Purpose of the Study:
- To investigate the relationship between heart transplantation experience and patient mortality.
- To assess the impact of institutional and team experience on heart transplant outcomes.
Main Methods:
- Data from 1123 heart transplant recipients at 56 US hospitals (1984-1986) were analyzed.
- Merged data from the International Society for Heart and Lung Transplantation registry and a supplemental survey.
- Statistical analyses included univariate, bivariate, and logistic regression techniques.
Main Results:
- A significant learning curve was observed: the first five transplants at a center had higher mortality (20%) than later ones (12%, P=0.002).
- New centers with cardiologists previously trained in heart transplantation showed lower mortality (7%) compared to those without (16%, P=0.001).
- Surgeon experience did not correlate with transplant mortality rates.
Conclusions:
- Heart transplantation experience is directly associated with improved patient outcomes.
- Transplantation policies can be refined based on center and team experience.
- Similar experience-based policies may benefit other organ transplantation programs.