TY - JOUR
T1 - Variations in cardiac transplantation
T2 - Comparisons between the United Kingdom and the United States
AU - Anyanwu, Ani C.
AU - Rogers, Chris A.
AU - Murday, Andrew J.
N1 - Funding Information:
This work was funded by the Department of Health. The views expressed are those of the authors and not necessarily of the Department of Health. This study would not have been possible without access to US data; we are indebted to Samia Buckingham and other staff at the UNOS Research Department for providing us with UNOS data. We thank our UK center data co-ordinators who provided the UK data. Sharon Beer, Yvonne Davenport, Jane Harte, Andrea Husain, Ian Martin, Lindsay Reynolds, Sheilagh Vidler, Bruce Whitehead and Neil Wrightson.
PY - 1999/4
Y1 - 1999/4
N2 - Background: International practice variations have been documented in various health care specialties. This study compares cardiac transplantation in the UK with practice in the US. Methods: UK data were from an ongoing multi-center prospective study, the UK Cardiothoracic Transplant Audit. The UK population comprised 620 listings and 463 transplants. US data were obtained from UNOS and comprised 3946 listings and 4704 transplants. Results: There was a mean of 14 transplants per center per year in the US compared with 34 in the UK. Notable differences in practice include rarity of listing in the UK of patients > 65 years (0.2% vs 4.1% in US) and patients with previous transplants (UK 0.9%, US 3.2%). Patients listed in the US were more likely to be on ventricular assist devices (odds ratio 8.0, 95% CI 3.0-21.7) or inotropes (odds ratio 4.9, 95% CI 3.7-6.4). Living donor (domino) transplants, although comprising 7% of transplants in the UK, are virtually non-existent in the US (1 domino in 4704 transplants). Heterotopic transplants were more common in the UK (4.4% vs 0.5%). Indications for transplant were similar (except retransplantation). The donor age was >35 years in 43% of UK donors vs 33% of US donors. Conclusion: This study reveals substantial practice differences between the UK and US. Further studies are required to examine the reasons for these practice differences, the influence on transplant outcome, and their ethical and economic implications.
AB - Background: International practice variations have been documented in various health care specialties. This study compares cardiac transplantation in the UK with practice in the US. Methods: UK data were from an ongoing multi-center prospective study, the UK Cardiothoracic Transplant Audit. The UK population comprised 620 listings and 463 transplants. US data were obtained from UNOS and comprised 3946 listings and 4704 transplants. Results: There was a mean of 14 transplants per center per year in the US compared with 34 in the UK. Notable differences in practice include rarity of listing in the UK of patients > 65 years (0.2% vs 4.1% in US) and patients with previous transplants (UK 0.9%, US 3.2%). Patients listed in the US were more likely to be on ventricular assist devices (odds ratio 8.0, 95% CI 3.0-21.7) or inotropes (odds ratio 4.9, 95% CI 3.7-6.4). Living donor (domino) transplants, although comprising 7% of transplants in the UK, are virtually non-existent in the US (1 domino in 4704 transplants). Heterotopic transplants were more common in the UK (4.4% vs 0.5%). Indications for transplant were similar (except retransplantation). The donor age was >35 years in 43% of UK donors vs 33% of US donors. Conclusion: This study reveals substantial practice differences between the UK and US. Further studies are required to examine the reasons for these practice differences, the influence on transplant outcome, and their ethical and economic implications.
UR - https://www.scopus.com/pages/publications/0032940215
U2 - 10.1016/S1053-2498(98)00051-5
DO - 10.1016/S1053-2498(98)00051-5
M3 - Article
C2 - 10226893
AN - SCOPUS:0032940215
SN - 1053-2498
VL - 18
SP - 297
EP - 303
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 4
ER -