Skip to main content

State-Level Variation in Waitlist Mortality and Transplant Outcomes Among Patients Listed for Heart Transplantation in the US From 2011 to 2016.

Publication ,  Journal Article
Akintoye, E; Shin, D; Alvarez, P; Briasoulis, A
Published in: JAMA network open
December 2020

Little is known about geographic variation in the outcomes of adult patients listed for heart transplantation in the US. Identifying the patterns and extent of variation is important to minimize disparity in outcomes.To evaluate the geographic patterns, extent, and factors associated with state-level variation in outcomes of adult patients listed for heart transplantation in the US.This nationwide retrospective cohort study used data from the United Network for Organ Sharing database to identify adult patients listed for heart transplantation at status 1A between January 1, 2011, and December 31, 2016. Patients were followed up until March 31, 2018. Data were analyzed from November 1, 2019, to September 19, 2020.The study evaluated state-level variation in the 3 main organ transplant measures: waitlist mortality, transplant rate, and risk-adjusted 1-year graft survival. The rate of death while on the waitlist and the rate of transplant were calculated for each state per 1000 waitlist person-days listed at status 1A over the study period. Risk-adjusted 1-year graft survival was calculated based on the Scientific Registry of Transplant Recipients risk-adjustment model. State-level variation in each outcome measure was evaluated via multivariable-adjusted models.Across 50 states and the District of Columbia, a total of 15 036 patients (mean [SD] age, 52 [13] years; 3531 women [24%]; 9626 White [64%]) were listed at status 1A for adult heart transplantation between 2011 and 2016. Of those, 2146 patients (14.3%) died while on the waitlist, and 10 982 patients (73.0%) received transplants. Among those who received transplants, the median time on the waitlist was 31 days (interquartile range, 13-61 days). State-level outcomes ranged from 1.0 to 7.8 deaths per 1000 waitlist person-days for waitlist mortality, 5.6 to 34.5 transplants per 1000 waitlist person-days for transplant rate, and 87% to 92% for risk-adjusted 1-year graft survival. In a comparison of the highest and lowest quartiles, significant state-level variation was found in waitlist mortality (hazard ratio [HR], 1.53; 95% CI, 1.27-1.86), transplant rate (HR, 1.57; 95% CI, 1.31-1.87), and 1-year graft survival (odds ratio, 2.07; 95% CI, 1.64-2.62).The study's findings indicate that significant state-level variation exists in the outcomes of patients listed for heart transplantation in the US. Identifying and addressing the factors associated with these geographic variations in outcomes is important to ensure a fair allocation system.

Altmetric Attention Stats
Dimensions Citation Stats

Published In

JAMA network open

DOI

EISSN

2574-3805

ISSN

2574-3805

Publication Date

December 2020

Volume

3

Issue

12

Start / End Page

e2028459

Related Subject Headings

  • Waiting Lists
  • United States
  • Risk Adjustment
  • Outcome Assessment, Health Care
  • Mortality
  • Middle Aged
  • Male
  • Humans
  • Heart Transplantation
  • Heart Diseases
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Akintoye, E., Shin, D., Alvarez, P., & Briasoulis, A. (2020). State-Level Variation in Waitlist Mortality and Transplant Outcomes Among Patients Listed for Heart Transplantation in the US From 2011 to 2016. JAMA Network Open, 3(12), e2028459. https://doi.org/10.1001/jamanetworkopen.2020.28459
Akintoye, Emmanuel, Doosup Shin, Paulino Alvarez, and Alexandros Briasoulis. “State-Level Variation in Waitlist Mortality and Transplant Outcomes Among Patients Listed for Heart Transplantation in the US From 2011 to 2016.JAMA Network Open 3, no. 12 (December 2020): e2028459. https://doi.org/10.1001/jamanetworkopen.2020.28459.
Akintoye, Emmanuel, et al. “State-Level Variation in Waitlist Mortality and Transplant Outcomes Among Patients Listed for Heart Transplantation in the US From 2011 to 2016.JAMA Network Open, vol. 3, no. 12, Dec. 2020, p. e2028459. Epmc, doi:10.1001/jamanetworkopen.2020.28459.

Published In

JAMA network open

DOI

EISSN

2574-3805

ISSN

2574-3805

Publication Date

December 2020

Volume

3

Issue

12

Start / End Page

e2028459

Related Subject Headings

  • Waiting Lists
  • United States
  • Risk Adjustment
  • Outcome Assessment, Health Care
  • Mortality
  • Middle Aged
  • Male
  • Humans
  • Heart Transplantation
  • Heart Diseases