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CLINICAL STUDIES

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

Keith D. Aaronson, MD, MS^* and Donna M. Mancini, MD

^* Division of Cardiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
Division of Circulatory Physiology, College of Physicians and Surgeons, Columbia University, New York, New York, USA

Manuscript received August 13, 1998; revised manuscript received November 10, 1998, accepted December 23, 1998.

Reprint requests and correspondence: Keith Aaronson, University of Michigan Health System, Division of Cardiology, Taubman 3910, Ann Arbor, Michigan 48109-0366
keith{at}umich.edu

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.

Abbreviations and Acronyms   ALL = entire cohort at HUP (or CPMC)   ACE = angiotensin-converting enzyme   CHF = congestive heart failure   CPMC = Columbia-Presbyterian Medical Center   HUP = Hospital of the University of Pennsylvania   LVAD = left ventricular assist device   NYHA = New York Heart Association   Peak O2 = peak exercise oxygen consumption   UNOS = United Network for Organ Sharing   6M = patients who survived for 6 months on the UNOS status 2 waiting list without receiving UNOS status 1 transplant or LVAD

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