Pediatric Heart Transplantation Over 36 Years and Contemporary Volume-Outcome Analysis of UNOS

Omar M Sharaf; Ahmet Bilgili; Zachary Brennan; John A Treffalls; Giles J Peek; Mark S Bleiweis; Jeffrey P Jacobs

doi:10.1016/j.athoracsur.2024.05.003

Pediatric Heart Transplantation Over 36 Years and Contemporary Volume-Outcome Analysis of UNOS

Ann Thorac Surg. 2024 May 20:S0003-4975(24)00377-1. doi: 10.1016/j.athoracsur.2024.05.003. Online ahead of print.

Authors

Omar M Sharaf¹, Ahmet Bilgili¹, Zachary Brennan², John A Treffalls³, Giles J Peek¹, Mark S Bleiweis¹, Jeffrey P Jacobs⁴

Affiliations

¹ Congenital Heart Center, University of Florida, Gainesville, Florida.
² Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
³ University of Texas Health San Antonio, San Antonio, Texas.
⁴ Congenital Heart Center, University of Florida, Gainesville, Florida. Electronic address: jeffreyjacobs@ufl.edu.

PMID: 38777247
DOI: 10.1016/j.athoracsur.2024.05.003

Abstract

Background: This study examines 36 years of national pediatric heart transplantation data to 1) identify trends in transplant volume, centers, and one-year graft survival, and 2) assess how center transplant volume impacts outcomes over a contemporary 11-year period.

Methods: We performed a retrospective review of pediatric patients (<18 years) undergoing heart transplantation from 1/1/1987 to 12/31/2022 using the United Network for Organ Sharing Database. Trend analyses included the whole cohort, while volume-outcome analyses included a contemporary cohort to account for the temporal changes observed in transplant survival. Highest volume centers were defined by the number of heart transplants performed per center per year.

Results: Over 36 years, 11,828 pediatric heart transplants were performed. Transplant volume steadily rose, the number of centers remained stable, and one-year graft survival has improved significantly. In the contemporary era (2012-2022), 89 centers conducted 4,959 pediatric heart transplants. The top 15% high-volume centers (13 centers) accounted for 48.3% (2,393) of transplants, with an average of 16.7±3.8 transplants per center annually, compared to 3.9±3.1 for lower volume centers. Despite transplanting higher risk patients, high-volume centers had similar postoperative outcomes and improved long-term survival.

Conclusions: While the number of US pediatric heart transplant centers has remained stable, pediatric heart transplant volume is steadily increasing, as is one-year graft survival. In a contemporary cohort, the top 15^th percentile highest volume centers accounted for 48.3% of US pediatric heart transplants and transplanted higher risk patients with similar postoperative outcomes and improved longitudinal survival.