Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.
Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.
J Surg Res. 2024 Apr;296:431-440. doi: 10.1016/j.jss.2024.01.016. Epub 2024 Feb 5.
The goal of this study was to evaluate the relationship between hospital-related factors and hospital type on outcomes of heart transplantation for patients with adult congenital heart disease (ACHD).
Patients with ACHD who underwent heart transplant between 2010 and 2021 were identified using the United Network for Organ Sharing data registry. The primary outcome was post-transplant mortality. Kaplan-Meier unadjusted survival curves were compared using the log-rank test. Multivariable Cox proportional hazard models were used for risk-adjustment in evaluating the independent effect of hospital type on post-transplant mortality.
Of 70 centers, 54 (77.1%) adult centers performed 415 (87.0%) heart transplants and 16 (22.9%) pediatric centers performed 62 (13.0%) heart transplants. Patients transplanted at pediatric centers were younger, had lower creatinine levels, and had lower body mass index. The unadjusted 1-y and 5-y survival was comparable in pediatric versus adult centers, respectively: 93.4% versus 86.6% (log-rank P = 0.16) and 87.4% versus 73.9% (log-rank P = 0.06). These findings persisted after risk-adjustment. One-year mortality hazard ratio for pediatric hospitals: 0.64 (0.22-1.89, P = 0.416) and 5-y mortality hazard ratio for pediatric hospitals: 0.53 (0.21-1.33, P = 0.175). Rates of acute rejection, postoperative stroke, and new-onset postoperative dialysis were also comparable.
Heart transplantation for patients with ACHD can be performed safely in adult centers. The majority of heart transplant for ACHD in the United States are performed at adult hospitals. However, further research is needed to delineate the impact of individual surgeon characteristics and hospital-related factors on outcomes.
本研究旨在评估医院相关因素和医院类型与成人先天性心脏病（ACHD）患者心脏移植结局的关系。
使用美国器官共享网络数据登记处，确定了 2010 年至 2021 年间接受心脏移植的 ACHD 患者。主要结局是移植后死亡。使用对数秩检验比较未经调整的移植后生存 Kaplan-Meier 生存曲线。多变量 Cox 比例风险模型用于风险调整，以评估医院类型对移植后死亡率的独立影响。
在 70 个中心中，54 个（77.1%）成人中心进行了 415 例（87.0%）心脏移植，16 个（22.9%）儿科中心进行了 62 例（13.0%）心脏移植。在儿科中心接受移植的患者年龄较小，肌酐水平较低，体重指数较低。儿科中心与成人中心的未调整 1 年和 5 年生存率相当，分别为：93.4%比 86.6%（对数秩 P=0.16）和 87.4%比 73.9%（对数秩 P=0.06）。这些发现在风险调整后仍然存在。儿科医院的 1 年死亡率风险比为 0.64（0.22-1.89，P=0.416），儿科医院的 5 年死亡率风险比为 0.53（0.21-1.33，P=0.175）。急性排斥反应、术后中风和新发性术后透析的发生率也相似。
成人中心可为 ACHD 患者安全进行心脏移植。美国大多数 ACHD 心脏移植都是在成人医院进行的。然而，需要进一步研究来阐明个别外科医生特征和医院相关因素对结局的影响。
