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Related Experiment Videos

The center effect in heart transplantation.

R W Evans1, F B Dong, D L Manninen

  • 1Health and Population Research Center, Battelle-Seattle Research Center, Washington.

Clinical Transplants
|January 1, 1991
PubMed
Summary

Heart transplant outcomes show variation by center, but clinical factors like artificial device use and retransplantation are key predictors. Center experience did not reach statistical significance, suggesting heart transplantation is broadly applicable.

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Area of Science:

  • Cardiovascular Surgery
  • Transplant Medicine
  • Health Services Research

Background:

  • Transplant center variation in outcomes suggests a "center effect," with experience often cited as a primary factor.
  • Previous studies on kidney transplants show mixed results regarding program activity and outcomes.
  • Limited data exists on the heart transplant center effect, with only one prior unpublished report.

Purpose of the Study:

  • To investigate the heart transplant center effect on patient survival.
  • To identify predictors of heart transplant outcomes, including center-specific factors and patient/donor characteristics.

Main Methods:

  • Utilized data from the International Society for Heart and Lung Transplantation Registry, HCFA, AHA, and a special purpose survey.
  • Combined data from 4 sources for 1,602 patients across 114 heart transplant centers.
  • Employed a discrete piecewise exponential hazards model, a nonparametric approach, to assess risk up to 2 years post-transplant.

Main Results:

  • Overall 1-year patient survival was 82.4%.
  • Clinical factors, specifically artificial device use and retransplantation, were significant adverse predictors of survival.
  • Center experience showed a positive but statistically non-significant association with patient survival.

Conclusions:

  • While outcomes varied by center, the extent of variation was less than anticipated.
  • Clinical characteristics, not sociodemographic factors, were the primary determinants of heart transplant success.
  • Heart transplantation appears to be a robust technology applicable across diverse settings with generally excellent outcomes.

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