Association of Heart Transplant Volume with Presence of Lung Transplant Programs and Heart Transplant’s SRTR One-year Survival Rating

Abstract

Background Several factors affect heart transplant (HTx) and lung transplant (LTx) program outcomes. Variabilities in institutional and community characteristics have been shown to influence survival. At present, half of HTx centers in the United States do not possess a concomitant LTx program. This study sought to better understand the characteristics of HTx with and without LTx programs.

Methods Nationwide transplant data were collected from the Scientific Registry of Transplant Recipients (SRTR) in August 2020. SRTR star rating ranges from tier 1 (lowest) to tier 5 (highest). HTx volumes and SRTR star ratings for survival were compared between the centers with heart-only (H0) programs and the centers with heart-lung (HL) programs.

Results SRTR star ratings were available for 117 transplant centers with one or more HTx reported. The median number of HTx performed over 1 year was 16 (interquartile range [IQR]: 2–29). The number of HL centers (n = 67, 57.3%) were comparable to H0 centers (n = 50, 42.7%; p = 0.14). The HTx volume at the HL centers (28 [IQR: 17–41]) exceeded the HTx volume at the H0 centers (13 [IQR: 9–23]; p < 0.01), but were comparable to the LTx volume at the HL centers (31 [IQR: 16–46]; p = 0.25). The median HTx one-year survival rating was 3 (IQR: 2–4) at both the H0 and HL centers (p = 0.85). The HTx and LTx volumes were positively associated with the respective 1-year survivals (p < 0.01).

Conclusion While the presence of an LTx program is not directly associated with HTx survival, it has a positive association with the HTx volume. The HTx and LTx volumes are positively associated with the 1-year survival.

Keywords

cardiac transplantation - heart transplantation - lung transplantation - survival - outcomes

Authors' Contribution

JLR was responsible for the concept/design, data collection, data verification and quality assurance, data interpretation, data analysis, and drafting of the article. DA was responsible for concept/design, data collection, data verification and quality assurance, data analysis, supervision of data analysis, drafting of the article, critical revision of the article, and interpretation. AU performed data collection, data verification and quality assurance, concept/design, data interpretation, and statistics. AB was responsible for drafting the article, data verification and quality assurance, critical revision of the article, data interpretation, and concept/design. GG was responsible for data collection, concept/design, data analysis, and data interpretation. IR, JER, RJA, KR, JWE, and HTM were responsible for concept/design, critical revision of the article, drafting of the article, and data interpretation. VT was responsible for concept/design, data verification and quality assurance, supervision of data analysis, drafting of the article, critical revision of the article, and approval of the article as the principal investigator.

Publication History

Received: 06 January 2023

Accepted: 15 May 2023

Accepted Manuscript online:
17 May 2023

Article published online:
15 July 2023

• References

• 1 Ahmad FB, Anderson RN. The leading causes of death in the US for 2020. JAMA 2021; 325 (18) 1829-1830
• 2 Rana JS, Khan SS, Lloyd-Jones DM, Sidney S. Changes in mortality in top 10 causes of death from 2011 to 2018. J Gen Intern Med 2021; 36 (08) 2517-2518
• 3 Heron M, Anderson RN. Changes in the leading cause of death: recent patterns in heart disease and cancer mortality. NCHS Data Brief 2016; (254) 1-8
• 4 Virani SS, Alonso A, Benjamin EJ. et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2020 Update: a report from the American Heart Association. Circulation 2020; 141 (09) e139-e596
• 5 Colvin M, Smith JM, Ahn Y. et al. OPTN/SRTR 2019 Annual Data Report: Heart. Am J Transplant 2021; 21 (Suppl. 02) 356-440
• 6 Blitzer D, Copeland H, Roe D. et al. Long term survival after lung transplantation: A single center experience. J Card Surg 2020; 35 (02) 273-278
• 7 Everly MJ. Cardiac transplantation in the United States: an analysis of the UNOS registry. Clin Transpl 2008; 35-43
• 8 DeFilippis EM, Khush KK, Farr MA, Fiedler A, Kilic A, Givertz MM. Evolving characteristics of heart transplantation donors and recipients: JACC focus seminar. J Am Coll Cardiol 2022; 79 (11) 1108-1123
• 9 Tsuang W, Khedraki R, Hsich E. Disparities in heart and lung transplantation. Curr Opin Organ Transplant 2021; 26 (05) 521-530
• 10 Mooney JJ, Bhattacharya J, Dhillon GS. Effect of broader geographic sharing of donor lungs on lung transplant waitlist outcomes. J Heart Lung Transplant 2019; 38 (02) 136-144
• 11 Akintoye E, Shin D, Alvarez P, Briasoulis A. State-level variation in waitlist mortality and transplant outcomes among patients listed for heart transplantation in the US from 2011 to 2016. JAMA Netw Open 2020; 3 (12) e2028459
• 12 Schulze PC, Kitada S, Clerkin K, Jin Z, Mancini DM. Regional differences in recipient waitlist time and pre- and post-transplant mortality after the 2006 United Network for Organ Sharing policy changes in the donor heart allocation algorithm. JACC Heart Fail 2014; 2 (02) 166-177
• 13 Davies RR, Haldeman S, Pizarro C. Regional variation in survival before and after pediatric heart transplantation: an analysis of the UNOS database. Am J Transplant 2013; 13 (07) 1817-1829
• 14 Hallett A, Motter JD, Frey A. et al. Trends in heart and lung transplantation in the United States across the COVID-19 pandemic. Transplant Direct 2021; 7 (10) e759
• 15 DeFilippis EM, Sinnenberg L, Reza N. et al. Trends in US heart transplant waitlist activity and volume during the coronavirus disease 2019 (COVID-19) pandemic. JAMA Cardiol 2020; 5 (09) 1048-1052
• 16 Pearce WH, Parker MA, Feinglass J, Ujiki M, Manheim LM. The importance of surgeon volume and training in outcomes for vascular surgical procedures. J Vasc Surg 1999; 29 (05) 768-776 , discussion 777–778
• 17 Morche J, Mathes T, Pieper D. Relationship between surgeon volume and outcomes: a systematic review of systematic reviews. Syst Rev 2016; 5 (01) 204
• 18 Shuhaiber JH, Moore J, Dyke DB. The effect of transplant center volume on survival after heart transplantation: a multicenter study. J Thorac Cardiovasc Surg 2010; 139 (04) 1064-1069
• 19 Menachem JN, Lindenfeld J, Schlendorf K. et al. Center volume and post-transplant survival among adults with congenital heart disease. J Heart Lung Transplant 2018; 37 (11) 1351-1360
• 20 Barbero C, Ravaglioli A, Page AA. et al. Retrieval team-initiated early donor management increases the donor heart utilization rate for transplantation. Eur J Cardiothorac Surg 2019; 55 (03) 468-475
• 21 Smith JW, O'Brien KD, Dardas T. et al. Systematic donor selection review process improves cardiac transplant volumes and outcomes. J Thorac Cardiovasc Surg 2016; 151 (01) 238-243
• 22 Tran ZK, Nelson DB, Martens TP. et al. Impact of transplant center volume on donor heart offer utilization rates in the United States. J Card Surg 2021; 36 (12) 4527-4532
• 23 Nguyen VP, Dolgner SJ, Dardas TF, Verrier ED, McMullan DM, Krieger EV. Improved outcomes of heart transplantation in adults with congenital heart disease receiving regionalized care. J Am Coll Cardiol 2019; 74 (23) 2908-2918
• 24 Magruder JT, Shah AS, Crawford TC. et al. Simulated regionalization of heart and lung transplantation in the United States. Am J Transplant 2017; 17 (02) 485-495
• 25 Breathett K, Knapp SM, Addison D. et al. Relationships between 2018 UNOS heart policy and transplant outcomes in metropolitan, micropolitan, and rural settings. J Heart Lung Transplant 2022; 41 (09) 1228-1236