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Updated: Jun 16, 2026
A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
The effect of transplant center volume on survival after heart transplantation: a multicenter study
Jeffrey H Shuhaiber1, Jeff Moore, David B Dyke
1Department of Cardiovascular Surgery, Harvard Medical School, Boston, MA, USA. jeffrey.shuhaiber@gmail.com
Insights
Higher volume heart transplant centers are associated with better patient survival. Patients receiving heart transplants at lower-volume centers face increased early mortality risk.
Area of Science:
- Cardiology
- Transplantation Surgery
- Outcomes Research
Background:
- Limited research exists on the link between procedural volume and clinical outcomes in heart transplantation.
- Understanding the impact of transplant center volume is crucial for improving patient survival rates.
Purpose of the Study:
- To investigate the association between heart transplant center volume and 1-year mortality.
- To determine if higher transplant volumes correlate with improved short-term survival.
Main Methods:
- Retrospective analysis of 13,230 heart transplantations from the Scientific Registry of Transplant Recipients (1999-2005).
- Centers were categorized into quartiles (very low, low, medium, high) based on procedural volume.
- Cox proportional hazards modeling was used to assess the relationship between center volume and 1-year mortality, adjusting for covariates.
Main Results:
- A statistically significant inverse relationship was observed between transplant center volume and 1-year mortality.
- Compared to very low-volume centers, higher-volume centers demonstrated progressively lower hazard ratios for 1-year mortality (low: 0.71, medium: 0.64, high: 0.56).
- Larger centers performed transplants in older candidates and accepted organs from older donors with longer cold ischemia times.
Conclusions:
- Heart transplant center volume is significantly associated with 1-year patient survival.
- Patients undergoing cardiac transplantation at very low-volume centers have a higher risk of early mortality compared to those at higher-volume centers.
Objective:
Few studies have examined the association between procedural volume and clinical outcomes in heart transplantation. This retrospective study was performed on a contemporary cohort of heart transplant recipients to better elucidate the effect of transplant center volume on 1-year mortality.
Methods:
Data from the Scientific Registry of Transplant Recipients were used to analyze the relationship between transplant center volume and short-term survival. Center volume designation (very low, low, medium, and high) was assigned on the basis of quartiles with approximately equal numbers of patients per group. Survival differences were explored using Cox proportional hazards modeling to adjust for differences in variables between volume groups and to determine variables associated with 1-year mortality.
Results:
Between January 1, 1999, and May 31, 2005, 13,230 heart transplantations were performed at 147 transplant centers in the United States. Although most recipient and donor characteristics were similar across quartiles, larger volume centers were more likely to perform transplantations in older candidates and accept organs from older donors with longer cold ischemia times. A statistically significant relationship between transplant center volume and 1-year mortality was observed. Compared with the reference group (very low volume), the hazard ratios for the low, medium, and high-volume quartiles were 0.71, 0.64, and 0.56, respectively (P < .001 for each group compared with the reference).
Conclusion:
There was a significant association between transplant center volume and 1-year survival. Patients who undergo cardiac transplantation at very low-volume centers are at higher risk for early mortality than those who undergo transplantation in higher-volume centers.
