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.
CITATION STYLE
Nguyen, V. P., Dolgner, S. J., Dardas, T. F., Verrier, E. D., McMullan, D. M., & Krieger, E. V. (2019). Improved Outcomes of Heart Transplantation in Adults With Congenital Heart Disease Receiving Regionalized Care. Journal of the American College of Cardiology, 74(23), 2908–2918. https://doi.org/10.1016/j.jacc.2019.09.062
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