Inferior Outcomes on the Waiting List in Low-Volume Pediatric Heart Transplant Centers

• DOI: 10.1111/ajt.14252
• Publication Date: 2017-03-02T02:33:26Z
• Authors: A. Rana; C.D. Fraser; B.B. Scully; J.S. Heinle; E.D. McKenzie; W.J. Dreyer; M. Kueht; H. Liu; E.D. Brewer; T.K. Rosengart; C.A. O’Mahony; J.A. Goss
• Keywords: Graft Rejection; Male; Hospitals, Low-Volume; Tissue and Organ Procurement; Adolescent; Waiting Lists; Graft Survival; Infant, Newborn; Infant; Prognosis; 3. Good health; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Risk Factors; Child, Preschool; Heart Transplantation; Humans; Female; Child; Follow-Up Studies; Retrospective Studies

Low case volume has been associated with poor outcomes in a wide spectrum of procedures. Our objective was to study the association low and worse pediatric heart transplant centers, taking novel approach including waitlist analysis. We studied cohort 6482 candidates listed Organ Procurement Transplantation Network for transplantation between 2002 2014; 4665 (72%) underwent transplantation. Candidates were divided into groups according average annual listing center during period: more than 10, six three five, or fewer transplantations. used multivariate Cox regression analysis identify independent risk factors posttransplantation mortality. Of candidates, 24% low-volume centers (fewer transplantations). these only 36% received versus 89% high-volume (more 10 transplantations) (p < 0.001). Listing at most significant factor death (hazard ratio [HR] 4.5, 95% confidence interval [CI] 3.5–5.7 HR 5.6, CI 4.4–7.3 competing regression) (HR 1.27, 1.0–1.6 regression). During period, one-fourth centers. These children had limited rate much greater dying while on waitlist.