Post–Heart Transplant Survival Is Inferior at Low-Volume Centers Across All Risk Strata

Russo, Mark J.; Iribarne, Alexander; Easterwood, Rachel; Ibrahimiye, Ali N.; Davies, Ryan R.; Hong, Kimberly N.; Ascheim, Deborah D.; Gelijns, Annetine C.; Naka, Yoshifumi

doi:10.1161/circulationaha.109.926659

Cited by 65 publications

(58 citation statements)

References 22 publications

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“…The characteristics of each study are described in Table 1. 1,[15][16][17][18][19][20][21][22][23][24] One study conducted in the United States before 1987 used data from US centers in the ISHLT registry, combined with data obtained directly from transplant centers. 15 Two studies used data from the ISHLT registry.…”

Section: Study Selectionmentioning

confidence: 99%

“…1,16 Four studies used data from the United Network for Organ Sharing (UNOS) registry. [17][18][19][20] One study used data from the Eurotransplant registry. 21 Two studies used Italian and Brazilian national registry data, respectively.…”

Section: Study Selectionmentioning

confidence: 99%

“…22,23 The number of centers included in each study ranged from 16 to 265 and number of patients from 798 to 14 401. Six studies included only adult patients, 1,[18][19][20][21]23 and 4 studies included both pediatric and adult patients. [15][16][17]22 Study populations overlapped between registries and over time; these interrelationships are shown in Figure 2.…”

Section: Study Selectionmentioning

confidence: 99%

“…One study assessed the composite outcome of all-cause mortality or need for repeat transplantation. 20 Six studies presented unadjusted (observed) mortality, [16][17][18][19]22,23 which ranged from 12.6% 19 to 34.1%. 22 All studies also presented mortality adjusted for baseline characteristics, with the exception of a single Italian study.…”

Section: Outcome Measures and Analysismentioning

confidence: 99%

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How Small Is Too Small? A Systematic Review of Center Volume and Outcome After Cardiac Transplantation

Pettit

Jhund²,

Hawkins³

et al. 2012

Circ: Cardiovascular Quality and Outcomes

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Background-The aim of this study was to assess the relationship between the volume of cardiac transplantation procedures performed in a center and the outcome after cardiac transplantation. Methods and Results-PubMed, Embase, and the Cochrane library were searched for articles on the volume-outcome relationship in cardiac transplantation. Ten studies were identified, and all adopted a different approach to data analysis and varied in adjustment for baseline characteristics. The number of patients in each study ranged from 798 to 14 401, and observed 1-year mortality ranged from 12.6% to 34%. There was no association between the continuous variables of center volume and observed mortality. There was a weak association between the continuous variables of center volume and adjusted mortality up to 1 year and a stronger association at 5 years. When centers were grouped in volume categories, low-volume centers had the highest adjusted mortality, intermediate-volume centers had lower adjusted mortality, and high-volume centers had the lowest adjusted mortality but were not significantly better than intermediate-volume centers. Category limits were arbitrary and varied between studies. Conclusions-There is a relationship between center volume and mortality in heart transplantation. The existence of a minimum acceptable center volume or threshold is unproven. However, a level of 10 to 12 heart transplants per year corresponds to the upper limit of low-volume categories that may have relatively higher mortality. It is not known whether outcomes for patients treated in low-volume transplant centers would be improved by reorganizing centers to ensure volumes in excess of 10 to 12 heart transplants per year. (Circ Cardiovasc Qual Outcomes. 2012;5:783-790.)

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Section: Study Selectionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: Outcome Measures and Analysismentioning

confidence: 99%

See 2 more Smart Citations

How Small Is Too Small? A Systematic Review of Center Volume and Outcome After Cardiac Transplantation

Pettit

Jhund²,

Hawkins³

et al. 2012

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

show abstract

“…26 Despite data supporting HT among select elderly patients, a recent analysis of the United Network for Organ Sharing (a U.S. registry) found only 1.3% of total transplants were performed in recipients more than 70 years old. 23 Furthermore, since transplant volume appears to have a high impact on post-HT outcomes, 27,28 we would advocate transplantation in elderly patients be preferentially considered in higher-volume centers.…”

Section: Heart Transplantationmentioning

confidence: 99%