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Updated: Oct 19, 2025
A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
Paradoxical outcome of heart transplantation associated with institutional case volume
Zhizhou Yang1, Melanie P Subramanian1, Yan Yan2
1Washington University School of Medicine, Division of Cardiothoracic Surgery, St. Louis, Missouri, USA.
Insights
Higher heart transplant volumes up to 24 cases annually improve 1-year survival. Optimal survival rates for heart transplantation are seen between 24-38 cases per year, with slightly decreased survival beyond this volume.
Area of Science:
- Cardiology
- Transplant Surgery
- Health Services Research
Background:
- Previous research indicates a link between hospital case volume and patient outcomes in heart transplantation.
- Understanding this relationship is crucial for optimizing patient care and resource allocation in transplant centers.
Purpose of the Study:
- To identify the specific institutional case volume associated with the best 1-year survival rates following heart transplantation.
- To analyze the non-linear association between heart transplant center volume and patient outcomes.
Main Methods:
- Analysis of the United Network for Organ Sharing (UNOS) national database.
- Inclusion of 11,196 adult heart transplant cases from 128 centers (2013-2017).
- Application of risk-adjusted restricted cubic splines and Cox models with segmented linear splines to assess survival.
Main Results:
- A non-linear association was observed between institutional case volume and 1-year post-transplant survival.
- Increased heart transplant volume up to 24 cases/year correlated with improved survival.
- Optimal 1-year survival was maintained for centers performing 24-38 heart transplants annually.
Conclusions:
- The relationship between heart transplant volume and 1-year survival is non-linear.
- An institutional case volume of 24-38 heart transplants per year is associated with optimal 1-year survival.
- Volumes exceeding 38 transplants per year showed a slight decrease in 1-year survival rates.
Background:
Previous studies in heart transplantation have shown an association between institutional case volume and outcomes. We aim to determine the case volume associated with optimal 1-year survival after transplantation.
Methods And Results:
The United Network for Organ Sharing (UNOS) national database was analyzed for adult patients who underwent orthotopic heart transplantation between January 2013 and December 2017. A total of 11,196 cases at 128 transplant centers were included. Risk-adjusted restricted cubic splines revealed a non-linear association between institutional case volume and 1-year post-transplant survival. In the risk-adjusted, random-effect Cox model with segmented linear splines, higher heart transplant volume up to 24 cases per year was associated with better 1-year survival (HR = .978 every additional case, 95% CI .963-.993), and optimal survival was maintained between 24 and 38 cases per year. However, further increase in volume above 38 transplants per year was associated with mildly decreased 1-year survival (HR = 1.007 every additional case, 95% CI 1.002-1.013).
Conclusions:
The relationship between institutional case volume and heart transplant 1-year survival is non-linear, with optimal survival observed at institutional case volume of 24-38 cases per year.
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