Inferior Outcomes on the Waiting List in Low-Volume Pediatric Heart Transplant Centers

A. Rana, C. D. Fraser, B. B. Scully, J. S. Heinle, E. D. McKenzie, W. J. Dreyer, Michael Kueht, H. Liu, E. D. Brewer, T. K. Rosengart, C. A. O'Mahony, J. A. Goss

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Low case volume has been associated with poor outcomes in a wide spectrum of procedures. Our objective was to study the association of low case volume and worse outcomes in pediatric heart transplant centers, taking the novel approach of including waitlist outcomes in the analysis. We studied a cohort of 6482 candidates listed in the Organ Procurement and Transplantation Network for pediatric heart transplantation between 2002 and 2014; 4665 (72%) of the candidates underwent transplantation. Candidates were divided into groups according to the average annual transplantation volume of the listing center during the study period: more than 10, six to 10, three to five, or fewer than three transplantations. We used multivariate Cox regression analysis to identify independent risk factors for waitlist and posttransplantation mortality. Of the 6482 candidates, 24% were listed in low-volume centers (fewer than three annual transplantations). Of these listed candidates in low-volume centers, only 36% received a transplant versus 89% in high-volume centers (more than 10 annual transplantations) (p < 0.001). Listing at a low-volume center was the most significant risk factor for waitlist death (hazard ratio [HR] 4.5, 95% confidence interval [CI] 3.5–5.7 in multivariate Cox regression and HR 5.6, CI 4.4–7.3 in multivariate competing risk regression) and was significant for posttransplantation death (HR 1.27, 95% CI 1.0–1.6 in multivariate Cox regression). During the study period, one-fourth of pediatric transplant candidates were listed in low-volume transplant centers. These children had a limited transplantation rate and a much greater risk of dying while on the waitlist.

Original languageEnglish (US)
Pages (from-to)1515-1524
Number of pages10
JournalAmerican Journal of Transplantation
Volume17
Issue number6
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

Fingerprint

Cardiac Volume
Waiting Lists
Transplantation
Pediatrics
Transplants
Confidence Intervals
Tissue and Organ Procurement
Organ Transplantation
Heart Transplantation
Regression Analysis
Mortality

Keywords

  • clinical research/practice
  • heart transplantation/cardiology
  • patient survival
  • pediatrics
  • waitlist management

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Rana, A., Fraser, C. D., Scully, B. B., Heinle, J. S., McKenzie, E. D., Dreyer, W. J., ... Goss, J. A. (2017). Inferior Outcomes on the Waiting List in Low-Volume Pediatric Heart Transplant Centers. American Journal of Transplantation, 17(6), 1515-1524. https://doi.org/10.1111/ajt.14252

Inferior Outcomes on the Waiting List in Low-Volume Pediatric Heart Transplant Centers. / Rana, A.; Fraser, C. D.; Scully, B. B.; Heinle, J. S.; McKenzie, E. D.; Dreyer, W. J.; Kueht, Michael; Liu, H.; Brewer, E. D.; Rosengart, T. K.; O'Mahony, C. A.; Goss, J. A.

In: American Journal of Transplantation, Vol. 17, No. 6, 01.06.2017, p. 1515-1524.

Research output: Contribution to journalArticle

Rana, A, Fraser, CD, Scully, BB, Heinle, JS, McKenzie, ED, Dreyer, WJ, Kueht, M, Liu, H, Brewer, ED, Rosengart, TK, O'Mahony, CA & Goss, JA 2017, 'Inferior Outcomes on the Waiting List in Low-Volume Pediatric Heart Transplant Centers', American Journal of Transplantation, vol. 17, no. 6, pp. 1515-1524. https://doi.org/10.1111/ajt.14252
Rana A, Fraser CD, Scully BB, Heinle JS, McKenzie ED, Dreyer WJ et al. Inferior Outcomes on the Waiting List in Low-Volume Pediatric Heart Transplant Centers. American Journal of Transplantation. 2017 Jun 1;17(6):1515-1524. https://doi.org/10.1111/ajt.14252
Rana, A. ; Fraser, C. D. ; Scully, B. B. ; Heinle, J. S. ; McKenzie, E. D. ; Dreyer, W. J. ; Kueht, Michael ; Liu, H. ; Brewer, E. D. ; Rosengart, T. K. ; O'Mahony, C. A. ; Goss, J. A. / Inferior Outcomes on the Waiting List in Low-Volume Pediatric Heart Transplant Centers. In: American Journal of Transplantation. 2017 ; Vol. 17, No. 6. pp. 1515-1524.
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