EFFICACY OF A PARTNERSHIP IN ENHANCING VETERANS AFFAIRS CARDIAC TRANSPLANTATION ACTIVITY

Background. Despite a nationwide surplus of cardiac transplantation pr ograms, the number of United States armed forces veterans who receive heart transplants has declined over the past several years. This study reviews the efficacy of a partnership between a Veterans Affairs hosp ital and a university hospital in maximizing the access of veterans to the limited donor heart supply. Methods. As part of a contract-based sharing agreement between the University of Wisconsin Hospital and the William S. Middleton Memorial Veterans Affairs Hospital, 25 veterans underwent orthotopic heart transplantation between October 1993 and Ap ril 1995. Care of the patients was provided at the Veterans Affairs Ho spital. The transplantation operations were performed at the Universit y of Wisconsin Hospital, and all patients were transferred back to the Veterans Affairs Hospital 5 to 7 days afterward. All patients were me n (mean age, 52.1 +/- 2.1 years) and were referred from Veterans Affai rs hospitals in nine different states. Results. During the 19-month pe riod, the average length of hospital stay for pretransplantation evalu ation was 7.0 +/- 0.7 days (range, 2 to 15 days). Average status I wai ting time was 26.9 +/- 3.3 days (range, 5 to 54 days); the average wai ting time for status II was 115.1 +/- 16 days (range, 15 to 242 days). Posttransplantation length of stay at the Veterans Affairs Hospital w as 22 +/- 1.8 days (range, 11 to 41 days). Only 1 patient (4%) experie nced a lethal postoperative complication. Ten patients (40%) exhibited graft rejection within the first month after transplantation, requiri ng treatment with augmented immunosuppressive therapy (steroids, orall y in 2 patients and intravenously in 8). The overall 30-day mortality rate was 4% (1 patient). The cause of death was acute grade 4 graft re jection 3 weeks after transplantation. Overall patient survival was 96 %. Conclusions. A partnership between a Veterans Affairs hospital and a university hospital committed to transplantation can increase Vetera ns Affairs cardiac transplantation activity, with excellent 30-day mor tality and early survival results.