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Transplants: Do more or do none
Newswise — Heart
surgeons at Johns Hopkins have evidence to
support further tightening rather than
easing of standards used to designate
hospitals that are best at performing heart
In a study presented
Jan. 29 at the 44th annual meeting of the
Society of Thoracic Surgeons in Fort
Lauderdale, Fla., the Hopkins team
recommends that the benchmark for
designation as a high-volume hospital rise
from 10 heart transplants per year to 14.
High-volume centers consistently show higher
survival and fewer complication rates.
However, the standard,
which is officially set by the U.S. Centers
for Medicare and Medicaid Services and which
qualifies medical centers for federal
reimbursement, was recently lowered from 12
per year to 10.
“The bar for patient
safety, quality of care and survival needs
to be set pretty high,” says senior study
investigator and cardiac surgeon John Conte,
“Our national health
care system has to rethink which hospitals
should do heart transplants, and in
consultation with their physicians, patients
need to evaluate these surgical volumes to
see for themselves which hospitals have
teams operating at their peak skill level.”
Conte and his team
reviewed the patient records of 14,401 men
and women who received a heart transplant in
the United Stats between 1999 and 2006.
The study is believed
to be the largest and most thorough review
of survival rates after heart
transplantation in hospitals, based on
“Our results clearly
demonstrate that current standards have been
arbitrarily set too low,” says Conte, who is
director of heart and lung transplantation
at The Johns Hopkins Hospital.
In the new study,
researchers found that death rates one month
and one year after transplant increased
steadily at hospitals that performed fewer
than 14 heart transplants per year, which
was the case for a majority of the 143 U.S.
medical centers licensed to perform them.
Roughly a dozen
institutions perform more than 20 cases
annually - including The Johns Hopkins
Hospital and the University of Maryland
Medical Center - and fewer than 10 hospitals
do more than 30 procedures, with no more
than five sites performing more than 40.
Study results showed
that the overall average death rate one year
after surgery was 12.6 percent.
However, patients had a
16 percent greater chance of dying in a
hospital that performed fewer than five
heart transplants per year and had the best
chances of surviving, with a 30-day
mortality rate of less than 1 percent, at a
hospital that performed over 40 procedures
Patients at hospitals
with volumes of less than 10 had an 80
percent greater chance of dying within a
Using a graph and
statistical analysis, researchers showed
that death rates flattened for the majority
of patients in hospitals with heart
transplant volumes at 14 or more per year.
Conte, an associate
professor of surgery at The Johns Hopkins
University School of Medicine and its Heart
Institute, says heart-failure patients on
transplant wait lists should consult with
their cardiologists about hospital and
surgeon volumes when making decisions about
and study co-investigator Stuart Russell,
M.D., who has personally cared for more than
360 transplant patients in the past decade,
says patients should also look for
consistently high volumes over several years
as well as overall survival rates for
One-year survival rates
at The Johns Hopkins Hospital, he notes,
consistently average above 90 percent.
Despite the team’s
findings, Russell says it will take a clear
shift in public health policy to move
American medicine toward further
concentration of volumes for complex
procedures such as heart transplantation.
In the United Kingdom,
he points out, centers designated to
performed heart transplants are severely
restricted, and volumes soar past 50 for
More than 2,000 people
undergo heart transplants each year in the
Nearly 3,000 remain on
wait lists, and up to 20 percent of those on
the list to receive a heart will die while
waiting. Costs for a heart transplant often
run as high as $260,000.
This study’s data were
supplied by the United Network for Organ
Sharing ((UNOS), a national network that
allocates donated organs across the country.
Funding for the study was supplied in part
by The Johns Hopkins Hospital.
Besides Conte and
Russell, other Hopkins investigators
involved in this study were lead researcher
Eric Weiss., M.D.; Robert Meguid, M.D.;
Nishant Patel, B.A.; Ashish Shah, M.D.; and
William Baumgartner, M.D.
Increased mortality rates at low-volume,
orthotopic heart transplant centers; should
the optimal volume for defining centers of
excellence be increased?)