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 14401, 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.
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 14401, 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.
Authors: Nicholas A Haglund; Irene D Feurer; Rashid M Ahmad; Thomas G DiSalvo; Daniel J Lenihan; Mary E Keebler; Kelly H Schlendorf; John M Stulak; Mark A Wigger; Simon Maltais Journal: J Heart Lung Transplant Date: 2014-05-15 Impact factor: 10.247
Authors: Prateeti Khazanie; Bradley G Hammill; Chetan B Patel; Zubin J Eapen; Eric D Peterson; Joseph G Rogers; Carmelo A Milano; Lesley H Curtis; Adrian F Hernandez Journal: J Am Coll Cardiol Date: 2014-01-30 Impact factor: 24.094
Authors: Matthew J O'Connor; Xuemei Zhang; Heather Griffis; Brian T Fisher; Kelly D Getz; Yimei Li; Joseph W Rossano; Kimberly Y Lin; Danielle S Burstein; Yuan-Shung Huang; Richard Aplenc Journal: Pediatr Cardiol Date: 2021-11-15 Impact factor: 1.655
Authors: Abbas Rana; Eileen D Brewer; Brandi B Scully; Michael L Kueht; Matt Goss; Karim J Halazun; Hao Liu; N Thao N Galvan; Ronald T Cotton; Christine A O'Mahony Journal: Pediatr Nephrol Date: 2016-10-18 Impact factor: 3.714
Authors: Anne Tsampalieros; Gregory A Knoll; Nicholas Fergusson; Alexandria Bennett; Monica Taljaard; Dean Fergusson Journal: Can J Kidney Health Dis Date: 2017-10-19