Variations in cardiac transplantation: Comparisons between the United Kingdom and the United States

Background: International practice variations have been documented in vario us 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 U K Cardiothoracic Transplant Audit. The UK population comprised 620 listings and 463 transplants. US data were obtained from UNOS and comprised 3946 li stings and 4704 transplants. Results: There was a mean of 14 transplants per center per year in the US c ompared with 34 in the UK. Notable differences in practice include rarity o f listing in the UK of patients >65 years (0.2% vs 4.1% in US:) and patient s with previous transplants (UK 0.9%, US 3.2%). Patients listed in the US w ere 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 (dom ino) transplants, although comprising 7% of transplants in the UK, are virt ually non-existent in the US (1 domino in 4704 transplants). Heterotopic tr ansplants were more common in the UK (4.4% vs 0.5%). Indications for transp lant were similar (except retransplantation). The donor age was >35 years i n 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 p ractice differences, the influence on transplant outcome, and their ethical and economic implications.