Abstract 4047: High Volume Transplant Centers Achieve Better Post-transplant Survival In Low And High-risk Recipients
Purpose. Previous studies have demonstrated a relationship between increasing center volume and outcomes in cardiac transplant. The purpose of this study was to examine the relationship between center volume and outcome across recipient risk strata.
Methods. UNOS provided de-identified patient-level data. Analysis included 8,534 heart transplant recipients aged ≥18yo and transplanted 1/1/01–12/31/06. Follow-up was available through 2/3/09. The primary outcome was observed 1-yr post-transplant graft survival. Multivariate logistic regression was used to calculate expected 1-yr survival for recipients. Recipients were then stratified by expected 1-yr graft survival into terciles–low (LR), intermediate (IR), and high (HR) risk. Likewise, centers were stratified into terciles by mean annual transplant volume–low (0 – 4.3), intermediate (4.3–11.5), and high (≥11.5) volume. Chi2 was used to compare 1-yr survival at low and intermediate with high volume centers.
Results (Figure⇓). Among LR recipients, high-volume centers (94.1%) had a significantly better 1-yr survival than low (85.7%; p<0.001) or intermediate (90.1%; p=0.011) volume centers. Among IR recipients, there was a trend toward better survival in the high-volume centers (90.1%) compared with low (81.2%; p=0.075) or intermediate (90.8%; p=0.061) volume centers. Among HR recipients, high-volume centers (91.2%) had a significantly better 1-yr survival than at low (71.5%; p=0.011) or intermediate (72.6%; p<0.001) volume centers.
Conclusions. Compared with low and intermediate volume centers, high-volume centers achieved significantly better 1-year survival across all recipient risk strata.