Related Experiment Video
Updated: Jun 24, 2025
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Impact of institutional variables on centre performance in long-term survival after heart transplant
Weston E McDonald1, Khaled Shorbaji2, Maxwell Kilcoyne1
1Department of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA.
Insights
One-year survival after heart transplant does not predict longer-term outcomes. Unmeasured center-level factors significantly impact 5-year survival, indicating a need for further research into transplant center performance.
Area of Science:
- Cardiology
- Transplant Surgery
- Outcomes Research
Background:
- One-year survival is the standard metric for orthotopic heart transplantation (OHT) center performance.
- Predictive value of 1-year outcomes for longer-term OHT success remains unclear.
Purpose of the Study:
- To evaluate factors influencing longer-term center-level performance in OHT.
- To determine if 1-year post-OHT survival rates predict 5-year survival.
Main Methods:
- Analysis of United Network of Organ Sharing data for OHT recipients (2010-2021).
- Utilized multivariable Cox proportional hazard and mixed-effect models.
- Primary outcome: 5-year survival conditional on 1-year survival post-OHT.
Main Results:
- Center-level 1-year survival did not correlate with 5-year conditional survival (HR 0.99, P=0.198).
- Recipient race, creatinine, diabetes, and donor age predicted 5-year mortality.
- Significant between-center variability in 5-year mortality persisted after controlling for known factors.
Conclusions:
- Center performance at 1 year post-OHT does not predict outcomes between years 1 and 5.
- Unmeasured center-level factors are crucial for long-term OHT success.
- Further research is required to identify these unmeasured factors.
Objectives:
The gold standard metric for centre-level performance in orthotopic heart transplantation (OHT) is 1-year post-OHT survival. However, it is unclear whether centre performance at 1 year is predictive of longer-term outcomes. This study evaluated factors impacting longer-term centre-level performance in OHT.
Methods:
Patients who underwent OHT in the USA between 2010 and 2021 were identified using the United Network of Organ Sharing data registry. The primary outcome was 5-year survival conditional on 1-year survival following OHT. Multivariable Cox proportional hazard models assessed the impact of centre-level 1-year survival rates on 5-year survival rates. Mixed-effect models were used to evaluate between-centre variability in outcomes.
Results:
Centre-level risk-adjusted 5-year mortality conditional on 1-year survival was not associated with centre-level 1-year survival rates [hazard ratio: 0.99 (0.97-1.01, P = 0.198)]. Predictors of 5-year mortality conditional on 1-year survival included black recipient race, pre-OHT serum creatinine, diabetes and donor age. In mixed-effect modelling, there was substantial variability between centres in 5-year mortality rates conditional on 1-year survival, a finding that persisted after controlling for recipient, donor and institutional factors (P < 0.001). In a crude analysis using Kaplan-Meier, the 5-year survival conditional on 1-year survival was: low volume: 86.5%, intermediate volume: 87.5%, high volume: 86.7% (log-rank P = 0.52). These measured variables only accounted for 21.4% of the between-centre variability in 5-year mortality conditional on 1-year survival.
Conclusions:
Centre-level risk-adjusted 1-year outcomes do not correlate with outcomes in the 1- to 5-year period following OHT. Further research is needed to determine what unmeasured centre-level factors contribute to longer-term outcomes in OHT.
