Frequency and impact of delayed decisions regarding heart transplantation on long-term outcomes in patients with advanced heart failure
Eldrin F. Lewis, MD, MPH*,*,
Sui W. Tsang, BS*,
James C. Fang, MD, FACC*,
Gilbert H. Mudge, MD, FACC*,
John A. Jarcho, MD, FACC*,
Carol M. Flavell, MSN*,
Anju Nohria, MD*,
Michael M. Givertz, MD, FACC*,
Gregory S. Couper, MD ,
John G. Byrne, MD and
Lynne Warner Stevenson, MD, FACC*
* Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Cardiovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Figure 1 Distribution of patients based on decisions made by the Transplant Committee at the time of initial evaluation, with the percentage of the total population listed in parentheses. The number (%) of patients who were listed and transplanted in each group are described. Patients listed within 10 days of evaluation were considered "early listed," and patients listed after 10 days following the evaluation were considered "delayed-listed."
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Figure 2 (A) Kaplan-Meier survival curves for all-cause mortality before and after transplantation in eligible patients (n = 95) stratified by the time of listing after the initial evaluation. Patients who are never listed have a trend toward better survival, compared with patients listed for a transplant (p = 0.06). Patients not listed early have survival similar to patients listed early for a transplant. (B) Kaplan-Meier survival curves for all-cause mortality, censoring patients at the time of transplantation, to depict pretransplant mortality in eligible patients stratified by the time of listing after the initial evaluation. There were no differences in survival between the patients not listed and the patients either listed early or late.
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Figure 3 Overall survival of patients with and without a transplant based on the initial decision of the Transplant Committee. Potentially eligible patients (hatched bars) had worse outcomes than eligible patients (solid bars) both with and without a transplant.
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Figure 4 Kaplan-Meier survival curves for all-cause mortality before and after transplantation in all patients (n = 214) stratified by the initial decision of the Transplant Committee. Eligible and deferred patients had better survival than patients who were potentially eligible or ineligible at the time of the initial evaluation.
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