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Waiting list and post-transplant outcome in Sweden after national centralization of heart transplant surgery

Gjesdal, Grunde LU ; Rylance, Rebecca Tremain LU orcid ; Bergh, Niklas ; Dellgren, Göran ; Braun, Oscar Ö LU and Nilsson, Johan LU orcid (2024) In The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 43(8). p.1318-1325
Abstract

BACKGROUND: Previous studies have demonstrated an association between transplantation rate per center and postoperative mortality after heart transplantation. In 2011, Sweden centralized heart transplants and waiting lists, reducing the number of centers from 3 to 2. We aimed to assess the active waiting time and pre- and post-transplant mortality before and after centralization.

METHODS: Heart transplantations performed in Sweden between January 1, 2001 and December 31, 2020 were included. Background and donor organ supply data were collected from Scandiatransplant, the Swedish Thoracic Transplant Registry, and the Swedish Cardiac Surgery Registry. The Fine and Gray methods were applied to visualize cumulative incidence curves... (More)

BACKGROUND: Previous studies have demonstrated an association between transplantation rate per center and postoperative mortality after heart transplantation. In 2011, Sweden centralized heart transplants and waiting lists, reducing the number of centers from 3 to 2. We aimed to assess the active waiting time and pre- and post-transplant mortality before and after centralization.

METHODS: Heart transplantations performed in Sweden between January 1, 2001 and December 31, 2020 were included. Background and donor organ supply data were collected from Scandiatransplant, the Swedish Thoracic Transplant Registry, and the Swedish Cardiac Surgery Registry. The Fine and Gray methods were applied to visualize cumulative incidence curves and conduct competing risk regressions. A Cox model was used to adjust for factors influencing time to post-transplant death.

RESULTS: When comparing the two eras, the median active waiting time increased from 54 to 71 days (p = 0.015). The risk of mortality on the waiting list decreased in the later era (subhazard ratio 0.43; [95% confidence interval {CI} 0.25-0.74]; p = 0.002). The number of heart transplantation procedures (including pediatric patients) increased by 53%. There was a significant difference in organ utilization between eras (p = 0.033; chi-square test). 30-day and 1-year survival post-transplant rates for adults increased from 90.8% to 97.8% (p < 0.001) and from 87.9% to 94.6% (p < 0.001), respectively. 1-year mortality was reduced by 63% (hazard ratio 0.37; 95% CI 0.22-0.61).

CONCLUSIONS: This nationwide study examined patients listed for and undergoing heart transplantation before and after the centralization of waiting lists and surgeries in Sweden. Waiting list mortality decreased, and 1-year post-transplantation survival was improved.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Heart Transplantation/mortality, Waiting Lists/mortality, Sweden/epidemiology, Male, Female, Middle Aged, Adult, Registries, Adolescent, Survival Rate/trends, Retrospective Studies, Child, Young Adult, Time Factors, Follow-Up Studies, Child, Preschool, Tissue and Organ Procurement/statistics & numerical data
in
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
volume
43
issue
8
pages
1318 - 1325
publisher
Elsevier
external identifiers
  • scopus:85194425326
  • pmid:38744355
ISSN
1557-3117
DOI
10.1016/j.healun.2024.04.068
language
English
LU publication?
yes
additional info
Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.
id
ad89d673-8704-45ea-80e3-a8d2bdeeeb5e
date added to LUP
2024-09-09 09:37:59
date last changed
2025-07-16 08:31:40
@article{ad89d673-8704-45ea-80e3-a8d2bdeeeb5e,
  abstract     = {{<p>BACKGROUND: Previous studies have demonstrated an association between transplantation rate per center and postoperative mortality after heart transplantation. In 2011, Sweden centralized heart transplants and waiting lists, reducing the number of centers from 3 to 2. We aimed to assess the active waiting time and pre- and post-transplant mortality before and after centralization.</p><p>METHODS: Heart transplantations performed in Sweden between January 1, 2001 and December 31, 2020 were included. Background and donor organ supply data were collected from Scandiatransplant, the Swedish Thoracic Transplant Registry, and the Swedish Cardiac Surgery Registry. The Fine and Gray methods were applied to visualize cumulative incidence curves and conduct competing risk regressions. A Cox model was used to adjust for factors influencing time to post-transplant death.</p><p>RESULTS: When comparing the two eras, the median active waiting time increased from 54 to 71 days (p = 0.015). The risk of mortality on the waiting list decreased in the later era (subhazard ratio 0.43; [95% confidence interval {CI} 0.25-0.74]; p = 0.002). The number of heart transplantation procedures (including pediatric patients) increased by 53%. There was a significant difference in organ utilization between eras (p = 0.033; chi-square test). 30-day and 1-year survival post-transplant rates for adults increased from 90.8% to 97.8% (p &lt; 0.001) and from 87.9% to 94.6% (p &lt; 0.001), respectively. 1-year mortality was reduced by 63% (hazard ratio 0.37; 95% CI 0.22-0.61).</p><p>CONCLUSIONS: This nationwide study examined patients listed for and undergoing heart transplantation before and after the centralization of waiting lists and surgeries in Sweden. Waiting list mortality decreased, and 1-year post-transplantation survival was improved.</p>}},
  author       = {{Gjesdal, Grunde and Rylance, Rebecca Tremain and Bergh, Niklas and Dellgren, Göran and Braun, Oscar Ö and Nilsson, Johan}},
  issn         = {{1557-3117}},
  keywords     = {{Humans; Heart Transplantation/mortality; Waiting Lists/mortality; Sweden/epidemiology; Male; Female; Middle Aged; Adult; Registries; Adolescent; Survival Rate/trends; Retrospective Studies; Child; Young Adult; Time Factors; Follow-Up Studies; Child, Preschool; Tissue and Organ Procurement/statistics & numerical data}},
  language     = {{eng}},
  number       = {{8}},
  pages        = {{1318--1325}},
  publisher    = {{Elsevier}},
  series       = {{The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation}},
  title        = {{Waiting list and post-transplant outcome in Sweden after national centralization of heart transplant surgery}},
  url          = {{http://dx.doi.org/10.1016/j.healun.2024.04.068}},
  doi          = {{10.1016/j.healun.2024.04.068}},
  volume       = {{43}},
  year         = {{2024}},
}