Department of Pediatrics, Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri, USA.
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Pediatr Transplant. 2024 Mar;28(2):e14720. doi: 10.1111/petr.14720.
There are conflicting data regarding the relationship between center volume and outcomes in pediatric heart transplantation. Previous studies have not fully accounted for differences in case mix, particularly in high-risk congenital heart disease (CHD) groups. We aimed to evaluate the relationship between center volume and outcomes using the Pediatric Heart Transplant Society (PHTS) Registry and explore how case mix may affect outcomes.
A retrospective cohort study of all pediatric patients in the PHTS Registry who received a heart transplant from 2009 to 2018 was performed. Centers were divided into 5 groups based on average yearly transplant volume. The primary outcome was time to death or graft loss and outcomes were compared using Kaplan-Meier analysis.
There were 4583 cases among 55 centers included. There was no difference in time to death or graft loss by center volume in the entire cohort (p = .75), in patients with CHD (p = .79) or in patients with cardiomyopathy (p = .23). There was also no difference in time to death or graft loss by center size in patients undergoing transplant after Norwood, Glenn or Fontan (log rank p = .17, p = .31, and p = .10 respectively). There was a statistically significant difference in outcomes by center size in the positive crossmatch group (p < .0001), though no discernible pattern related to high or low center volume.
Outcomes are similar among transplant centers of all sizes, including for high-risk patient groups with CHD. Future work is needed to understand how patient-specific risk factors may vary among centers of various sizes and whether this influences patient outcomes.
儿科心脏移植中，中心容量与结果之间的关系存在相互矛盾的数据。以前的研究没有充分考虑病例组合的差异，特别是在高危先天性心脏病（CHD）组中。我们旨在使用儿科心脏移植协会（PHTS）注册中心评估中心容量与结果之间的关系，并探讨病例组合如何影响结果。
对 2009 年至 2018 年期间在 PHTS 注册中心接受心脏移植的所有儿科患者进行了回顾性队列研究。根据平均每年的移植量，将中心分为 5 组。主要结局是死亡或移植物丢失的时间，使用 Kaplan-Meier 分析比较结果。
共有 55 个中心的 4583 例患者纳入研究。整个队列中，中心容量与死亡或移植物丢失时间无关（p=0.75），在 CHD 患者（p=0.79）或心肌病患者（p=0.23）中也无关。在经历 Norwood、Glenn 或 Fontan 手术后接受移植的患者中，中心大小与死亡或移植物丢失时间也无关（对数秩检验 p=0.17、p=0.31 和 p=0.10）。在阳性交叉匹配组中，中心大小与结果存在统计学显著差异（p<0.0001），尽管与高或低中心容量无关。
所有大小的移植中心的结果相似，包括高危 CHD 患者群体。需要进一步研究如何在不同大小的中心之间，以及是否影响患者结局，来了解患者特定风险因素的差异。
