Department of Cardiovascular Surgery, Harvard Medical School, Boston, MA, USA.
J Thorac Cardiovasc Surg. 2010 Apr;139(4):1064-9. doi: 10.1016/j.jtcvs.2009.11.040. Epub 2010 Feb 8.
Few studies have examined the association between procedural volume and clinical outcomes in heart transplantation. This retrospective study was performed on a contemporary cohort of heart transplant recipients to better elucidate the effect of transplant center volume on 1-year mortality.
Data from the Scientific Registry of Transplant Recipients were used to analyze the relationship between transplant center volume and short-term survival. Center volume designation (very low, low, medium, and high) was assigned on the basis of quartiles with approximately equal numbers of patients per group. Survival differences were explored using Cox proportional hazards modeling to adjust for differences in variables between volume groups and to determine variables associated with 1-year mortality.
Between January 1, 1999, and May 31, 2005, 13,230 heart transplantations were performed at 147 transplant centers in the United States. Although most recipient and donor characteristics were similar across quartiles, larger volume centers were more likely to perform transplantations in older candidates and accept organs from older donors with longer cold ischemia times. A statistically significant relationship between transplant center volume and 1-year mortality was observed. Compared with the reference group (very low volume), the hazard ratios for the low, medium, and high-volume quartiles were 0.71, 0.64, and 0.56, respectively (P < .001 for each group compared with the reference).
There was a significant association between transplant center volume and 1-year survival. Patients who undergo cardiac transplantation at very low-volume centers are at higher risk for early mortality than those who undergo transplantation in higher-volume centers.
鲜有研究调查心脏移植中手术量与临床结局之间的关系。本回顾性研究对当代心脏移植受者队列进行分析，以更好地阐明移植中心手术量对 1 年死亡率的影响。
利用移植受者科学注册处的数据来分析移植中心手术量与短期存活率之间的关系。根据四分位数将中心手术量指定为（极低、低、中、高），每组的患者数量大致相等。使用 Cox 比例风险模型探索生存差异，以调整各体积组间的变量差异，并确定与 1 年死亡率相关的变量。
1999 年 1 月 1 日至 2005 年 5 月 31 日期间，美国 147 个移植中心共进行了 13230 例心脏移植手术。尽管各四分位数组间大多数受者和供者特征相似，但大手术量中心更有可能对年龄较大的受者进行移植，并接受来自冷缺血时间更长的老年供者的器官。观察到移植中心手术量与 1 年死亡率之间存在显著的关系。与参考组（极低手术量）相比，低、中、高手术量四分位数组的危险比分别为 0.71、0.64 和 0.56（与参考组相比，每组的 P 值均<.001）。
移植中心的手术量与 1 年存活率之间存在显著的关联。在低手术量中心接受心脏移植的患者比在高手术量中心接受移植的患者发生早期死亡的风险更高。
