Dushyanth Srinivasan1, Benjamin Vaccaro1, Pooja Rao2, Rohit Ghosh2, Prashant Warier2, Tariq Ahmad1, Nihar Desai1,3. 1. Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut. 2. Center for Outcomes Research and Evaluation, Qure.ai, Mumbai, India. 3. Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut.
Abstract
BACKGROUND: The number of heart transplants performed is limited by organ availability and is managed by the United Network for Organ Sharing (UNOS). Efforts are underway to make organ disbursement more equitable as demand increases. HYPOTHESIS: Significant variation exists in contemporary patterns of care, wait times, and outcomes among patients undergoing heart transplantation across UNOS regions. METHODS: We identified adult patients undergoing first, single-organ heart transplantation between January 2006 and December 2014 in the UNOS dataset and compared sociodemographic and clinical profiles, wait times, use of mechanical circulatory support (MCS), status at time of transplantation, and 1-year survival across UNOS regions. RESULTS: We analyzed 17 096 patients undergoing heart transplantation. There were no differences in age, sex, renal function, and peripheral vascular resistance across regions; however, there was 3-fold variation in median wait time (range, 48-166 days) across UNOS regions. Proportion of patients undergoing transplantation with status 1A ranged from 36% to 79% across regions (P < 0.01), and percentage of patients hospitalized at time of transplantation varied from 41% to 98%. There was also marked variation in MCS and inotrope utilization (28%-57% and 25%-58%, respectively; P < 0.001). Durable ventricular assist device implantation varied from 20% to 44% (P < 0.001), and intra-aortic balloon pump utilization ranged from 4% to 18%. CONCLUSIONS: Marked differences exist in patterns of care across UNOS regions that generally trend with differences in waitlist time. Novel policy initiatives are required to address disparities in access to allografts and ensure equitable and efficient allocation of organs.
BACKGROUND: The number of heart transplants performed is limited by organ availability and is managed by the United Network for Organ Sharing (UNOS). Efforts are underway to make organ disbursement more equitable as demand increases. HYPOTHESIS: Significant variation exists in contemporary patterns of care, wait times, and outcomes among patients undergoing heart transplantation across UNOS regions. METHODS: We identified adult patients undergoing first, single-organ heart transplantation between January 2006 and December 2014 in the UNOS dataset and compared sociodemographic and clinical profiles, wait times, use of mechanical circulatory support (MCS), status at time of transplantation, and 1-year survival across UNOS regions. RESULTS: We analyzed 17 096 patients undergoing heart transplantation. There were no differences in age, sex, renal function, and peripheral vascular resistance across regions; however, there was 3-fold variation in median wait time (range, 48-166 days) across UNOS regions. Proportion of patients undergoing transplantation with status 1A ranged from 36% to 79% across regions (P < 0.01), and percentage of patients hospitalized at time of transplantation varied from 41% to 98%. There was also marked variation in MCS and inotrope utilization (28%-57% and 25%-58%, respectively; P < 0.001). Durable ventricular assist device implantation varied from 20% to 44% (P < 0.001), and intra-aortic balloon pump utilization ranged from 4% to 18%. CONCLUSIONS: Marked differences exist in patterns of care across UNOS regions that generally trend with differences in waitlist time. Novel policy initiatives are required to address disparities in access to allografts and ensure equitable and efficient allocation of organs.
Authors: M Christian Williams; James H Creger; A Matthew Belton; Roger S Brown; Judith M Morrison; Mark A Hardy; John C McDonald; G Melville Williams; H Myron Kauffman Journal: Transplantation Date: 2004-03-15 Impact factor: 4.939
Authors: Paul J Hauptman; Peter Mikolajczak; Anil George; Clinton J Mohr; Robert Hoover; Jason Swindle; Mark A Schnitzler Journal: Am Heart J Date: 2006-12 Impact factor: 4.749
Authors: Josef Stehlik; Jeffrey D Hosenpud; Leah B Edwards; Marshall I Hertz; Mandeep R Mehra Journal: J Heart Lung Transplant Date: 2013-10 Impact factor: 10.247
Authors: Jose N Nativi; Abdallah G Kfoury; Craig Myrick; Melissa Peters; Dale Renlund; Edward M Gilbert; Feras Bader; Arun K Singhal; Melanie Everitt; Patrick Fisher; David A Bull; Craig Selzman; Josef Stehlik Journal: J Heart Lung Transplant Date: 2009-09-26 Impact factor: 10.247
Authors: Randall C Starling; Yoshifumi Naka; Andrew J Boyle; Gonzalo Gonzalez-Stawinski; Ranjit John; Ulrich Jorde; Stuart D Russell; John V Conte; Keith D Aaronson; Edwin C McGee; William G Cotts; David DeNofrio; Duc Thinh Pham; David J Farrar; Francis D Pagani Journal: J Am Coll Cardiol Date: 2011-05-10 Impact factor: 24.094