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Heart Transplant Waitlist Outcomes and Wait Time by Center Volume in the Pre-2018 Allocation Change Era
Andre Critsinelis1, Manish M Karamchandani2, Camille E Hironaka3
1From the Department of Surgery, Mount Sinai Medical Center, Miami Beach, FL.
Insights
Heart transplant waitlist outcomes are better at high-volume centers. Patients at high-volume centers had higher survival rates and lower rates of death or deterioration before receiving a heart transplant (HTx).
Area of Science:
- Cardiology
- Transplant Surgery
- Health Services Research
Background:
- Post-transplant outcomes and center volume are linked, but waitlist outcomes by center volume are less understood.
- Monitoring transplant center performance is crucial for patient care and resource allocation.
Purpose of the Study:
- To compare heart transplant (HTx) waitlist outcomes across different transplant center volumes.
- To identify factors influencing survival and outcomes for patients awaiting heart transplantation.
Main Methods:
- Retrospective analysis of adult primary heart transplant candidates from the United Network for Organ Sharing database (2008-2018).
- Centers categorized into low (<10), medium (10-30), and high (>30 HTx/year) volume.
- Comparison of waitlist outcomes including transplantation, death, deterioration, recovery, and left ventricular assist device (LVAD) implantation.
Main Results:
- High-volume centers demonstrated higher survival-to-transplant rates (71.3%) compared to low-volume (60.6%) and medium-volume (64.9%) centers.
- Low-volume centers were independently associated with higher rates of death or delisting before HTx (HR 1.18).
- Listing at high-volume centers (HR 0.86) and prelisting with an LVAD (HR 0.67) were protective factors against pre-transplant adverse outcomes.
Conclusions:
- Heart transplant waitlist outcomes, including death or delisting, are significantly better at higher-volume transplant centers.
- Center volume is a critical factor influencing the success of patients on the heart transplant waitlist.
- Strategies to improve waitlist outcomes may involve directing patients to higher-volume centers or optimizing pre-listing care.
Abstract:
Although the transplant outcomes of centers are heavily monitored and compared, with a particular link between posttransplant outcomes and center volume demonstrated, little data exist comparing waitlist outcomes. Here, we explored waitlist outcomes by transplant center volume. We performed a retrospective analysis of adults listed for primary heart transplantation (HTx) from 2008 to 2018 using the United Network for Organ Sharing database. Transplant centers were split into low (<10 HTx/year), medium (10-30 HTx/year), and high (>30 HTx/year) volume, and waitlist outcomes were compared. Of the 35,190 patients included in our study, 23,726 (67.4%) underwent HTx, 4,915 (14.0%) died or deteriorated before receiving HTx, 1,356 (3.9%) were delisted due to recovery, and 1,336 (3.8%) underwent left ventricular assist device (LVAD) implantation. High-volume centers had higher rates of survival to transplant (71.3% vs. 60.6% for low-volume centers and 64.9% for medium-volume centers), and low rates of death or deterioration (12.6% vs. 14.6% for low-volume centers and 15.1% for medium-volume centers). Listing at a low-volume center was independently associated with death or delisting before HTx (HR 1.18, p = 0.007), whereas listing at a high-volume center (HR 0.86; p < 0.001) and prelisting LVAD (HR 0.67, p < 0.001) were protective. Death or delisting before HTx was lowest for patients listed in higher volume centers.
