Survival does not differ by annual center transplant volume-A Pediatric Heart Transplant Society Registry study

Area of Science:

• Pediatric Cardiology
• Transplantation Medicine
• Health Services Research

Background:

• Conflicting data exist on the relationship between pediatric heart transplant center volume and patient outcomes.
• Previous studies may not have adequately addressed case mix differences, particularly in high-risk congenital heart disease (CHD) populations.
• Understanding the impact of center volume on outcomes is crucial for optimizing pediatric heart transplantation.

Purpose of the Study:

• To evaluate the association between pediatric heart transplant center volume and patient outcomes.
• To investigate whether case mix influences the relationship between center volume and outcomes.

Main Methods:

• Retrospective cohort study utilizing the Pediatric Heart Transplant Society (PHTS) Registry (2009-2018).
• Centers categorized into five groups based on average annual heart transplant volume.
• Primary outcome: time to death or graft loss, analyzed using Kaplan-Meier methods.

Main Results:

• Analysis of 4583 pediatric heart transplants across 55 centers revealed no significant difference in survival or graft loss based on center volume.
• This finding held true for the overall cohort, as well as for patients with congenital heart disease (CHD) and cardiomyopathy.
• No volume-outcome relationship was observed for patients undergoing transplantation post-Norwood, Glenn, or Fontan procedures, except for a significant difference in positive crossmatch cases without a clear volume pattern.

Conclusions:

• Pediatric heart transplant outcomes are comparable across centers of all sizes, including for high-risk CHD patients.
• Further research is required to explore patient-specific risk factors and their variation among centers of different volumes.