title: Influence of Transplant Center Procedural Volume on Survival Outcomes of Heart Transplantation for Children Bridged with Mechanical Circulatory Support.
abstract: Transplant center expertise improves survival after heart transplant (HTx) but it is unknown whether center expertise ameliorates risk associated with mechanical circulatory support (MCS) bridge to transplantation. This study investigated whether center HTx volume reduced survival disparities among pediatric HTx patients bridged with extracorporeal membrane oxygenation (ECMO), left ventricular assist device (LVAD), or no MCS. Patients ≤18 years of age receiving first-time HTx between 2005 and 2015 were identified in the United Network of Organ Sharing registry. Center volume was the total number of HTx during the study period, classified into tertiles. The primary outcome was 1 year post-transplant survival, and MCS type was interacted with center volume in Cox proportional hazards regression. The study cohort included 4131 patients, of whom 719 were supported with LVAD and 230 with ECMO. In small centers (≤133 HTx over study period), patients bridged with ECMO had increased post-transplant mortality hazard compared to patients bridged with LVAD (HR 0.29, 95% CI 0.12, 0.71; p = 0.006) and patients with no MCS (HR 0.33, 95% CI 0.19, 0.57; p < 0.001). Interactions of MCS type with medium or large center volume were not statistically significant, and the same differences in survival by MCS type were observed in medium- or large-volume centers (136-208 or ≥214 HTx over the study period). Post-HTx survival disadvantage of pediatric patients bridged with ECMO persisted regardless of transplant program volume. The role of institutional ECMO expertise outside the transplant setting for improving outcomes of ECMO bridge to HTx should be explored.
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Hsieh
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.|Center for the Epidemiological Study of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Tumin
authors.affiliation: Center for the Epidemiological Study of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.|Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Patrick I
authors.initials: PI
authors.lastname: McConnell
authors.affiliation: Center for the Epidemiological Study of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.|Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Galantowicz
authors.affiliation: Center for the Epidemiological Study of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA. hayes.705@osu.edu.|Center for the Epidemiological Study of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA. hayes.705@osu.edu.|Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA. hayes.705@osu.edu.|Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA. hayes.705@osu.edu.|Section of Pulmonary Medicine, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA. hayes.705@osu.edu.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006085:Graft Survival; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Center volume; Donor; Heart transplantation; Mechanical circulatory support; Recipient; Survival