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Right arrow Transplantation - heart

J Thorac Cardiovasc Surg 2004;127:1481-1485
© 2004 The American Association for Thoracic Surgery

Cardiothoracic transplantation

Survival of patients removed from the heart transplant waiting list

Nirav R. Shah, BAa, Joseph G. Rogers, MDb, Gregory A. Ewald, MDb, Michael K. Pasque, MDa, Edward M. Geltman, MDb, Marci S. Bailey, RNa, Nader Moazami, MDa,*

a Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo, USA,
b Division of Cardiology, Washington University School of Medicine, St Louis, Mo, USA

Presented at the annual meeting of The American Transplant Congress, Washington, DC, June 2003.

Received for publication August 24, 2003; revisions received November 4, 2003; accepted for publication December 9, 2003.

* Address for reprints: Nader Moazami, MD, Washington University School of Medicine, Barnes-Jewish Hospital, Department of Surgery, Division of Cardiothoracic Surgery, Queeny Tower—Suite 3108, One Barnes-Jewish Hospital Plaza, St Louis, MO 63110, USA
moazamin{at}msnotes.wustl.edu

OBJECTIVE: End-stage heart failure has been associated with high mortality in the absence of transplantation. We evaluated the outcome of patients receiving optimal medical therapy who were removed from the cardiac transplant waiting list to determine survival and predictors of mortality.

METHODS: We performed a retrospective review of 27 patients removed from the cardiac transplant waiting list from 1999 to 2001 at our institution.

RESULTS: Mean age was 53 ± 11 years; 16 of the patients were male. Status was IB in 3 cases and II in 24. Median time on the list was 32 months, and median follow-up was 2.9 years. Patients were removed from the transplant list because of either clinical improvement (group A, n = 18) or deterioration (group B, n = 9). In group A, 13 patients had improved functional status and 10 were in New York Heart Association class 1 or 2; 16 had improved echocardiographic left ventricular function. Survivals at 3 years were 100% in group A and 44% in group B (P < .01).

CONCLUSION: Patients with end-stage heart failure who have clinical response to medical therapy have excellent 3-year survival. These data suggest the necessity of close evaluation of patients waiting for transplantation, with a low threshold for inactivation if persistent clinical improvement is observed.






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