Improved survival of patients with end-stage heart failure listed for heart transplantation: analysis of organ procurement and transplantation network/U.S. United Network of Organ Sharing data, 1990 to 2005

Abstract

Objectives: We sought to investigate the actual survival of patients with end-stage heart failure listed for heart transplantation (HT) in the U.S.

Background: The United Network of Organ Sharing (UNOS) reported that the mortality rates on the U.S. HT waiting list have been gradually declining. This suggests that the survival of these patients may have improved.

Methods: The survival censored on the day of HT or removal from the waiting list was calculated for 18,004 UNOS status 1 and 30,978 status 2 candidates listed in eras I (1990 to 1994), II (1995 to 1999), and III (2000 to 2005) in the U.S. The Cox proportional model was employed for multivariable analysis.

Results: The 1-year survival on the HT waiting list improved from 49.5% to 69.0% for status 1 and from 81.8% to 89.4% for status 2 candidates between eras I and III. The predictors of death within 2 months from listing of status 1 candidates included UNOS status 1A, mechanical ventilation, inotropic and intra-aortic balloon pump support, pulmonary capillary wedge pressure >20 mm Hg and serum creatinine >1.5 mg/dl, failed HT, valvular cardiomyopathy, age >60 years, Caucasian ethnicity, and weight < or =70 kg, as well as the lack of intracardiac cardioverter-defibrillator on the day of listing.

Conclusions: Survival of HT candidates on the waiting list has significantly improved. Survival of status 1 candidates continues to depend on urgent HT. Predictors of 2-month mortality may help identify status 1 candidates who warrant the highest priority for HT and/or mechanical circulatory support. The 1-year survival of status 2 candidates approaches outcomes of HT, thus raising the question of whether early listing of some of these patients is justified.