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Selection of patients for heart transplantationin the current era of heart failure therapy

Javed Butler, MD, MPH, FACC^*||¶,*, Ghazanfar Khadim, MD^*, Kimberly M. Paul, MD, Stacy F. Davis, MD^*, Marvin W. Kronenberg, MD^*, Don B. Chomsky, MD^*¶, Richard N. Pierson, III, MD^# and John R. Wilson, MD^*

^* Division of Cardiovascular Medicine, Department of Medicine, Nashville, TennesseeUSA
Center for Health Services Research, Nashville, TennesseeUSA
Center for Education and Research in Therapeutics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Cardiology Division, Emory University, Atlanta, Georgia, USA
^|| Geriatric Research, Education, and Clinical Center, Nashville, TennesseeUSA
^¶ Medicine Service, Nashville Veterans Affairs Medical Center, Nashville, Tennessee, USA
^# Department of Cardiothoracic Surgery, University of Maryland, Baltimore, Maryland, USA

View larger version (13K): [in a new window]   Figure 1 Cumulative survival for patients in the past era and current era demonstrates a significantly better survival for patients in the current era. After an initial higher mortality rate after transplantation, overall one-year survival is comparable to medical therapy for patients in the current era and better than heart failure therapy in the past era.

View larger version (21K): [in a new window]   Figure 2 Improvement in one-year event-free survival was noted for patients in the current era of heart failure management for all peak exercise oxygen consumption (VO2) groups. Patients with a high-risk heart failure survival score (HFSS) showed the most improvement in survival. Survival for the intermediate-risk peak VO2 group was comparable to that after transplantation. Open bars = past era; solid bars = current era. *Vanderbilt Heart Failure Program. One-year post-transplant survival. #United Network for Organ Sharing 1990 to 2000.

View larger version (20K): [in a new window]   Figure 3 One-year event-free survival in the current era for the intermediate-risk groups stratified by beta-blockers and defibrillator therapy shows survival in patients with both therapies simultaneously to be comparable to that after transplantation. p > 0.2 for peak exercise oxygen consumption (VO2) and p = 0.07 for heart failure survival score (HFSS). Open bars = no beta-blocker therapy; dotted bars = beta-blocker therapy; solid bars = beta-blocker and defibrillator therapy.

View larger version (21K): [in a new window]   Figure 4 Suggested algorithm for selection of patients for heart transplantation, using peak exercise oxygen consumption (VO2) and heart failure survival score.