The Annals of thoracic surgery · 2024
Analysis of UNOS: Pediatric Heart Transplantation Over 36 Years and Contemporary Volume-Outcome Relationship.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Sharaf Omar M, Bilgili Ahmet, Brennan Zachary, Treffalls John A, Peek Giles J, Bleiweis Mark S, Jacobs Jeffrey P
Аннотация
BACKGROUND: This study examines 36 years of national pediatric heart transplantation data to (1) identify trends in transplant volume, centers, and 1-year graft survival and (2) assess how center transplant volume affects outcomes over a contemporary 11-year period.
METHODS: Study investigators utilized the United Network for Organ Sharing database and performed a retrospective review of pediatric patients (aged <18 years) who underwent heart transplantation between January 1, 1987 and December 31, 2022, inclusive. Trend analyses included the whole cohort, whereas volume-outcome analyses included a contemporary cohort (January 1, 2012 through December 31, 2022) to account for the temporal changes observed in transplant survival. Highest-volume centers were defined by the number of heart transplantations performed per center per year.
RESULTS: Over 36 years, 11,828 pediatric heart transplantations were performed. Transplant volume steadily rose, the number of centers remained stable, and 1-year graft survival improved significantly. In the contemporary era (2012-2022), 89 centers conducted 4959 pediatric heart transplantations. The top 15% high-volume centers (13 centers) accounted for 48.3% (n = 2393) of transplantations, with an average of 16.7 ± 3.8 transplantations per center annually, compared with 3.9 ± 3.1 for lower-volume centers (P < .001). Despite performing transplantations in higher-risk patients, high-volume centers achieved similar postoperative outcomes and improved long-term survival compared with low-volume centers.
CONCLUSIONS: Although the number of US pediatric heart transplant centers has remained stable, pediatric heart transplant volume has steadily increased, as has 1-year graft survival. In a contemporary cohort, the top 15th percentile highest-volume centers accounted for 48.3% of US pediatric heart transplants and performed transplantations in higher-risk patients with similar postoperative outcomes and improved longitudinal survival.
METHODS: Study investigators utilized the United Network for Organ Sharing database and performed a retrospective review of pediatric patients (aged <18 years) who underwent heart transplantation between January 1, 1987 and December 31, 2022, inclusive. Trend analyses included the whole cohort, whereas volume-outcome analyses included a contemporary cohort (January 1, 2012 through December 31, 2022) to account for the temporal changes observed in transplant survival. Highest-volume centers were defined by the number of heart transplantations performed per center per year.
RESULTS: Over 36 years, 11,828 pediatric heart transplantations were performed. Transplant volume steadily rose, the number of centers remained stable, and 1-year graft survival improved significantly. In the contemporary era (2012-2022), 89 centers conducted 4959 pediatric heart transplantations. The top 15% high-volume centers (13 centers) accounted for 48.3% (n = 2393) of transplantations, with an average of 16.7 ± 3.8 transplantations per center annually, compared with 3.9 ± 3.1 for lower-volume centers (P < .001). Despite performing transplantations in higher-risk patients, high-volume centers achieved similar postoperative outcomes and improved long-term survival compared with low-volume centers.
CONCLUSIONS: Although the number of US pediatric heart transplant centers has remained stable, pediatric heart transplant volume has steadily increased, as has 1-year graft survival. In a contemporary cohort, the top 15th percentile highest-volume centers accounted for 48.3% of US pediatric heart transplants and performed transplantations in higher-risk patients with similar postoperative outcomes and improved longitudinal survival.