Journal of Heart and Lung Transplantation | 2019
Orthotopic Heart Transplant Volume Can Be Aggressively Increased While Maintaining Outcomes
Abstract
Purpose While volume-outcome relationships in transplantation have been well-defined, the effects of large swings in center volume are less well understood. The purpose of the current study was to examine the impact of changes in center volume on outcomes after heart transplantation. We hypothesize that rapid growth may be achieved without having a deleterious effect on outcomes. Methods Retrospective analysis was performed of adult patients undergoing heart transplant between 2000-2017 identified in the UNOS database. Exclusions included annual volume Results Of the 29,851 transplants during the study period, 64% were at centers with stable volume (±25% annual change), 10% were performed at decreasing (-25% change or more) and 26% were performed at growing (+25% change or more) centers. Average volume was lower with decreasing compared to stable or growing programs (21 vs. 36, p Conclusion Rapid growth of center volume can occur without decrement in programmatic outcomes. Careful patient selection among centers with changing volume may improve outcomes. Large decreases in transplant center volume are independently associated with increased short and long-term mortality after heart transplantation.