Date: Monday, June 4, 2018
Session Time: 2:30pm-4:00pm
Presentation Time: 3:30pm-3:42pm
Location: Room 4C-3
Purpose: Compliance after heart transplantation (HTx) is crucial to ensure adequate drug dosing and avoidance of complications especially within the first six months. To ensure care access and compliance, we have required all HTx patients (pts) within 2 months of surgery to reside within 120 min commuting time (CT) from our hospital. In a large metropolitan area, CT to the transplant center is highly dependent upon traffic. We used Google Maps to assess CT during clinic hours. We evaluated whether increased CT led to missed clinic visits, protocol biopsies(bx) or blood draws.
Methods: Between 2008-16 we assessed CT to our clinic for 655 HTx pts. Pts were divided by CT <30 min (n=76), 30-60 min (n=150), 60-90 min (n=155), 90-120 min (n=142), and >120 min (n=132) from the clinic. CT were correlated to non-compliance, defined as an unexcused missed scheduled visit, bx, or regular blood draw. In addition, CT were correlated to development of first-year rejection, infection and survival after HTx. CT were calculated individually and as an aggregate in the first 6 months after HTx.
Results: There was no difference in the mean number of unexcused missed visits between groups. Survival, rejection rates and freedom from infection were similar between all groups.
Conclusion: Policies to have recent HTx pts reside within 90-120 minutes CT to our transplant clinic may not be necessary. Longer CT to the transplant center does not appear to result in greater non-compliance rates.
|Endpoints||CT<30min (n=76)||CT 30-60min (n=150)||CT 60-90min (n=155)||CT 90-120min (n=142)||CT >120min (n=132)||P-Value|
|Mean #Unexcused Missed Visits ± SD||1.0 ± 1.0||1.2 ± 1.1||0.8 ± 1.0||1.0 ± 0.7||1.1 ± 0.9||0.510|
|1-Yr Freedom from Any-Treated Rejection||85.3%||84.7%||84.5%||88.7%||86.4%||0.857|
|1-Yr Freedom from Acute Cellular Rejection||94.7%||91.3%||94.2%||95.0%||93.9%||0.800|
|1-Yr Freedom from Antibody-Mediated Rejection||94.7%||95.3%||97.4%||96.5%||96.2%||0.851|
|1-Yr Freedom from Infection||51.3%||52.0%||46.5%||61.3%||50.0%||0.169|
CITATION INFORMATION: Velleca A., Kransdorf E., Patel J., Kittleson M., Dimbil S., Levine R., Geft D., Chang D., Czer L., Kobashigawa J. Do Recent Heart Transplant Patients Need to Reside Close to the Transplanting Center? A Look at the Impact of Commuting Times on Clinical Outcomes Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Velleca A, Kransdorf E, Patel J, Kittleson M, Dimbil S, Levine R, Geft D, Chang D, Czer L, Kobashigawa J. Do Recent Heart Transplant Patients Need to Reside Close to the Transplanting Center? A Look at the Impact of Commuting Times on Clinical Outcomes [abstract]. https://atcmeetingabstracts.com/abstract/do-recent-heart-transplant-patients-need-to-reside-close-to-the-transplanting-center-a-look-at-the-impact-of-commuting-times-on-clinical-outcomes/. Accessed October 22, 2020.
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