Author + information
- Received August 15, 2019
- Revision received September 17, 2019
- Accepted September 23, 2019
- Published online December 2, 2019.
- Vidang P. Nguyen, MDa,∗ (, )
- Stephen J. Dolgner, MDb,c,
- Todd F. Dardas, MD, MSa,
- Edward D. Verrier, MDd,
- D. Michael McMullan, MDe and
- Eric V. Krieger, MDa,c
- aDivision of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
- bDepartment of Pediatrics, University of Washington, Seattle, Washington
- cDivision of Cardiology, Seattle Children’s Hospital, Seattle, Washington
- dDivision of Cardiothoracic Surgery, University of Washington, Seattle, Washington
- eDivision of Cardiac Surgery, Seattle Children’s Hospital, Seattle, Washington
- ↵∗Address for correspondence:
Dr. Vidang P. Nguyen, University of Washington, 1959 Pacific Street, Box 356422, Seattle, Washington 98195.
Background The number of adult congenital heart disease (CHD) patients undergoing heart transplantation is increasing rapidly. CHD patients have higher surgical risk at transplantation. High-volume adult CHD transplant centers may have better transplant outcomes.
Objectives This study aimed to evaluate the effect of center CHD transplant volume and expertise on transplant outcomes in CHD patients.
Methods The authors studied heart transplantations in CHD patients age ≥18 years using the United Network of Organ Sharing (UNOS) database for the primary outcomes of waitlist mortality and post-transplant outcomes at 30 days and 1 year. Transplant centers were assessed by status as the highest CHD transplant volume center in a UNOS region versus all others, presence of Adult Congenital Heart Association accreditation, and adult versus pediatric hospital designation.
Results Between January of 2000 and June of 2018, 1,746 adult CHD patients were listed for transplant; 1,006 (57.6%) of these underwent heart transplantation. After adjusting for age, sex, listing status, and inotrope requirement, waitlist mortality risk was lower at Adult Congenital Heart Association accredited centers (hazard ratio: 0.730; p = 0.020). Post-transplant 30-day mortality was lower at the highest volume CHD transplant center in each UNOS region (hazard ratio: 0.706; p = 0.014).
Conclusions Designated expertise in CHD care is associated with improved waitlist outcomes for CHD patients listed for transplantation. Post-transplant survival was improved at the highest volume regional center. These findings suggest a possible advantage of regionalization of CHD transplantation.
- Adult Congenital Heart Association
- adult congenital heart disease
- heart transplantation
- United Network of Organ Sharing
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 15, 2019.
- Revision received September 17, 2019.
- Accepted September 23, 2019.
- 2019 American College of Cardiology Foundation
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