Abstract 4369025: Impact of New Heart Transplant Centers on Regional Transplant Volume and Outcomes

Abstract

Introduction: Heart transplantation (HT) is a critical therapy for patients with end stage heart failure. HT volumes have increased since 2010, but the demand for this therapy continues to surpass the supply of donor organs. Although initiation of new transplant centers may increase access to HT, their impact on regional transplant volume and subsequent clinical outcomes remain unclear. Research Question: What is the impact of starting a new or reactivating a closed HT center on regional transplant volume and patient outcomes of waitlist time, waitlist mortality, and 1-year post-transplant mortality? Methods: Data from the Scientific Registry of Transplant Recipients (SRTR), which includes data on all transplant candidates and recipients in the United States, were analyzed. New centers and re-opened centers (defined as 2 years of no transplants before restarting) from 2010 to 2023 were included. We used multivariable-adjusted Poisson mixed effects, competing risk, and Cox models to assess associations between center activity and volume, waitlist outcomes, and post-transplant mortality. Results: Seventeen new centers launched and five re-opened from 2010-2023, representing all 11 OPTN regions. In a majority of new center openings, total regional transplant volume increased without decrease in existing center volume (Figure 1). Addition of a new center did not significantly increase regional transplant volume or decrease waitlist time in the year after initiation. Reactivated centers were associated with an increased chance of receiving a transplant (HR 1.20, 95% CI [1.11, 1.28]) and lower waitlist mortality (HR 0.88, 95% CI [0.81, 0.86]). New centers were associated with higher waitlist mortality (HR 1.03, 95% CI [1.01, 1.05]), although a higher percentage of these patients had been in ICU prior to transplant. There was no difference in 1-year post-transplant mortality with either new or re-opened centers. Conclusions: Regional volume of transplants was higher following initiation of a new or reactivation of a closed HT center but this increase was not statistically significant after controlling for important variables. Similar post-transplant outcomes were observed, allaying concerns that center addition might negatively impact outcomes. Notably, re-opened centers were associated with improvement in wait time and waitlist mortality.