Mortality remains high for outpatient transplant candidates with prolonged (>6 months) waiting list time

Keith D. Aaronson, Donna M. Mancini

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

OBJECTIVES: The study aimed to determine the risk of death or urgent transplant for patients who survived an initial 6 months on the outpatient heart transplant waiting list when criteria emphasizing reduced peak oxygen consumption are used for transplant candidate selection. BACKGROUND: Waiting time is a key criterion for heart donor allocation. A recent single-center investigation described decreasing survival benefit from transplant for patients who survived an initial 6 months on the outpatient waiting list. METHODS: Kaplan-Meier survival analyses were performed for 80 patients from the Hospital of the University of Pennsylvania (HUP) listed from July 1986 to January 1991, and 132 patients from Columbia-Presbyterian Medical Center (CPMC) listed from september 1993 to September 1995. Survival from the time of outpatient listing for the entire group (ALL) was compared to subsequent survival from 6 months onward for those patients who survived the initial 6 months after placement on the outpatient list (6M). Both urgent transplant and left ventricular assist device implantation were considered equivalent to death; elective transplant was censored. RESULTS: Survival for 6M was not significantly better than ALL at HUP (subsequent 12 months: 60 ± 7 vs. 60 ± 6% [mean ± SD]; p = 0.89) nor at CPMC (subsequent 12 months: 60 ± 6 vs. 48 ± 5%; p = 0.35). Survival for 6M at both centers was substantially lower than survival following transplant from the outpatient list in the United States in 1995. CONCLUSIONS: When high-risk patients are selected for nonurgent transplant listing, mortality remains high, even among those who survive the initial six months after listing. Time accrued on the waiting list remains an appropriate criterion for donor allocation.

Original languageEnglish
Pages (from-to)1189-1195
Number of pages7
JournalJournal of the American College of Cardiology
Volume33
Issue number5
DOIs
StatePublished - Apr 1999
Externally publishedYes

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