Improvement in Heart Transplant Outcomes: From Medicare Flagging to Best in the World

Abstract

<h3>Purpose</h3> SRTR data has recently published that the University of Chicago Medical Center (UCMC) heart transplant (HTx) program possesses the highest one-year survival in the world despite being flagged in the past by Medicare. We assessed UCMC's HTx patient outcomes compared to those from other centers in the United States before and after 2015. <h3>Methods</h3> Using the United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research Database, we retrospectively reviewed heart transplants performed from January 1988 to September 2020. Re-transplants and multi-organ transplants were excluded. Survival was assessed with Kaplan-Meier method and compared by log-rank test. Univariate and multivariate cox regression analyses were performed to assess hazard ratios. <h3>Results</h3> A total of 69,174 patients were included in this study. Pre-2015, 1-year survival was 84.9% (95% CI 81.3-88.7) at UCMC versus 86.7% (95% CI 86.5-87) at other centers. Cox regression analyses found a trend towards greater risk for mortality in UCMC patients, HR 1.16 (95% CI 0.88-1.52, p = 0.286). These results were consistent in multivariate analysis adjusting for donor age and recipient age. Post-2015, 1-year survival was 95.7% (95% CI 92.4-99.1) versus 91.8% (95% CI 91.4-92.3) at other centers. Cox regression analyses showed a trend towards reduced hazard for mortality in UCMC patients, HR 0.49 (95% CI 0.22-1.10, p = 0.086). Relative to itself, there was a significant improvement in 1-year survival between the two time periods at UCMC, HR 0.25 (95% CI 0.11-0.59, p = 0.001). <h3>Conclusion</h3> There has been a large improvement in HTx outcomes at UCMC, accompanied by a restructuring and refinement of program practices in the year 2015. One-year survival at UCMC has gone from underperforming relative to other centers in the country to enjoying the highest survival in the nation.