Abstract
Transplantation represents the ultimate option for patients with advanced heart failure refractory to other treatments. We aimed to assess the between-center disparities in access to heart transplantation 1-year after listing in France by adjusting for candidate and center factors identified to be significantly associated with access to heart transplantation. Adults ( n = 2,347) registered on the French national waiting list between January 1, 2010 and December 31, 2014 in the 23 transplant centers were included. The association of candidate and transplant center characteristics with access to transplantation was assessed with mixed-effects Cox models. Within 1-year of listing, 65% of candidates underwent transplantation. Candidates blood type O and A, sensitization and body mass index ≥ 30 kg/m 2 were independently associated with lower access to transplantation, while female gender, heart failure severity and high serum bilirubin level were independently associated with greater access to transplantation. Center factors associated with access to transplantation were heart procurement rate in the geographic area, proportion of high-urgency candidates among listed patients and donor heart offer decline rate. Access to transplantation between-center variability increased by 5% after adjustment for candidate factors and decreased by 57% after adjustment for center factors. However, after adjustment for candidate and center factors, 5 centers were still outside of normal variability. Regional disparities in access to heart transplantation were largely driven by center factors. These findings will be taken into consideration in the future French heart allocation system with priority statuses defined according to objective candidate characteristics rather than medical management and with extending nationwide graft sharing to candidates without priority.
Published Version
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