Clinical InvestigationMortality, Resource Utilization, and Inpatient Costs Vary Among Pediatric Heart Transplant Indications: A Merged Data Set Analysis From the United Network for Organ Sharing and Pediatric Health Information Systems Databases
Section snippets
Data Source
Data were obtained from a merged UNOS-PHIS cohort of pediatric transplant recipients at participating centers from 2004 to 2015. UNOS is a nonprofit organization that collects data on every organ transplantation since 1987 in the United States. Information collected in UNOS includes detailed pre- and post-transplantation demographic and clinical information for donors and recipients, such as primary diagnosis, severity status, and follow-up information regarding mortality. PHIS is an
Patient and Center Characteristics
A total of 2251 pediatric heart transplantations (49% CHD, 5% myocarditis, 46% cardiomyopathy) from 26 US centers were included in the analysis. Among recipients with CHD, 22% had single-ventricle disease and 55% simple biventricular CHD. The majority (86%) of transplantations occurred in medium- to high-volume centers, defined as >10 transplants per year, owing to center volume homogeneity among participating PHIS institutions. Pre-transplantation characteristics of the recipients and donors
Discussion
This merged UNOS-PHIS data set has enabled a comprehensive evaluation of both pre-transplantation characteristics and post-transplantation outcomes and resource utilization among heart transplant indications in more than 2,200 pediatric heart transplantations in 26 US centers over the past decade. As hypothesized, CHD has greater resource utilization and inpatient costs despite poorer outcomes compared with other transplant indications, even after adjusting for pre-transplantation patient-level
Study Limitations
This study has several limitations. It is a retrospective observational analysis from a large multicenter cohort. Although patient-level factors were adjusted for in our analyses, there may be factors that were not captured and thus could not be included in our analysis. We identified that most transplantations in our cohort occurred at moderate- to large-volume transplant centers based on the represented centers participating in PHIS. We think that our findings are valid for centers of similar
Conclusion
Children with CHD, particularly single-ventricle disease, have poorer outcomes despite increased resource utilization and costs during the first year after transplantation compared with children with cardiomyopathy and myocarditis. Data from this merged database—UNOS combined with PHIS, an administrative hospital database—have enabled more granular pre- and post-transplantation analysis of patient- and center-level factors in children. Further work is aimed at identifying modifiable
Disclosures
None.
Previous Presentation
This study was presented at the 67th Annual Meeting and Scientific Session of the American College of Cardiology, Orlando, Florida, March 10–12, 2018, and the 38th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation, Nice, France, April 11–14, 2018.
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