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First-time status 1 heart transplant candidates: inevitably poor prognosis?
First-Time Status 1 Heart Transplant Candidates: Inevitably Poor Prognosis? G. Sahar, M. Berman, G. Georghiou, T. Ben Gal, A. Kogan, A. Stamler, D. Aravot, and B. Vidne
T
HE GROWING clinical success of cardiac transplantation has resulted in a dramatic increase in the number of patients referred and subsequently listed for cardiac transplantation. Due to a limited donor organ pool, waiting time for heart transplantation (Htx) is prolonged and many patients expire while waiting.1 The current United Network for Organ Sharing (UNOS) heart allocation system grants waiting list priority status (status 1) to patients awaiting Htx,2 currently in an intensive cardiac care unit (ICCU), and under one or more of the following regimens to support the failing heart: (1) intravenous inotropic support— dopamine and dobutamine, (2) intraaortic balloon, and (3) ventricular assist device. Winkel et al3 suggests that Htx candidates who require maintenance outpatient intravenous inotropic therapy represent a subgroup of UNOS status 2 candidates with greater waiting list morbidity, but with no greater waiting list mortality, than candidates who can be maintained on oral heart failure agents alone. However, the current UNOS heart allocation system provides for this increased illness acuity by assigning a higher priority status when necessary. The two goals for our study were; (1) to assess the outcome of Htx candidates listed at least once as status 1, and (2) to determine whether does status 1 has a prognostic predictive value. METHODS The retrospective study concerns the outcome of 34 Htx candidates, who have been accepted for Htx over a 3-year period from 1997 to 2000 and were at least once listed as status 1. The period of time spent on the waiting list until a final event (transplantation or death) was considered.
Fig 1. Outcome of heart transplantation by recipient’s UNOS status.
seven patients who died were listed directly at status 1 and none survived till transplantation. The rest of the Htx candidates still on the waiting list have a mean of 3.25 status 1 periods per patient. CONCLUSION
Our small cohort of patients demonstrates that patients who are placed on the waiting list at UNOS status 1 have a grave prognosis (100% mortality) compared to patients placed for the first time on the waiting list at UNOS status 2. Early diagnosis and referal for Htx is needed to improve the outcome of these patients. REFERENCES
RESULTS
1. Chen JM, Weiberg AD, Rose EA, et al: Ann Thorac Surg 61:570, 1996 2. Kauffman HM, McBride MA, Shield CF, et al: J Heart Lung Transplant 18:733, 1999 3. Winkel E, Kao W, Fisher SG, et al: J Heart Lung Transplant 17:809, 1998
The results are shown in Fig 1. Fourteen of 34 patients listed were transplanted during this period after a mean of 4.7 status 1 periods per patient (range 2 to 11). All of these patients were listed for the first time on the waiting list at status 2, and during status 1 periods they were treated with inotrops. Seven of the 34 patients died, after a mean of 1.3 periods per patient on status 1 (range 1 to 3). Five of the
From the Heart-Lung Transplant Unit, Department of Cardiothoracic Surgery, Rabin Medical Center (Beilinson Campus), Sackler Faculty of Medicine, Tel Aviv University, Petach-Tikva, Israel. Address reprint request to Dr G. Sahar, Heart-Lung Transplant Unit, Department of Cardiothoracic Surgery, Rabin Medical Center (Beilinson Campus), 49100 Petach-Tikva, Israel.
© 2001 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010 Transplantation Proceedings, 33, 2951 (2001)
0041-1345/01/$–see front matter PII S0041-1345(01)02267-9 2951
T
HE GROWING clinical success of cardiac transplantation has resulted in a dramatic increase in the number of patients referred and subsequently listed for cardiac transplantation. Due to a limited donor organ pool, waiting time for heart transplantation (Htx) is prolonged and many patients expire while waiting.1 The current United Network for Organ Sharing (UNOS) heart allocation system grants waiting list priority status (status 1) to patients awaiting Htx,2 currently in an intensive cardiac care unit (ICCU), and under one or more of the following regimens to support the failing heart: (1) intravenous inotropic support— dopamine and dobutamine, (2) intraaortic balloon, and (3) ventricular assist device. Winkel et al3 suggests that Htx candidates who require maintenance outpatient intravenous inotropic therapy represent a subgroup of UNOS status 2 candidates with greater waiting list morbidity, but with no greater waiting list mortality, than candidates who can be maintained on oral heart failure agents alone. However, the current UNOS heart allocation system provides for this increased illness acuity by assigning a higher priority status when necessary. The two goals for our study were; (1) to assess the outcome of Htx candidates listed at least once as status 1, and (2) to determine whether does status 1 has a prognostic predictive value. METHODS The retrospective study concerns the outcome of 34 Htx candidates, who have been accepted for Htx over a 3-year period from 1997 to 2000 and were at least once listed as status 1. The period of time spent on the waiting list until a final event (transplantation or death) was considered.
Fig 1. Outcome of heart transplantation by recipient’s UNOS status.
seven patients who died were listed directly at status 1 and none survived till transplantation. The rest of the Htx candidates still on the waiting list have a mean of 3.25 status 1 periods per patient. CONCLUSION
Our small cohort of patients demonstrates that patients who are placed on the waiting list at UNOS status 1 have a grave prognosis (100% mortality) compared to patients placed for the first time on the waiting list at UNOS status 2. Early diagnosis and referal for Htx is needed to improve the outcome of these patients. REFERENCES
RESULTS
1. Chen JM, Weiberg AD, Rose EA, et al: Ann Thorac Surg 61:570, 1996 2. Kauffman HM, McBride MA, Shield CF, et al: J Heart Lung Transplant 18:733, 1999 3. Winkel E, Kao W, Fisher SG, et al: J Heart Lung Transplant 17:809, 1998
The results are shown in Fig 1. Fourteen of 34 patients listed were transplanted during this period after a mean of 4.7 status 1 periods per patient (range 2 to 11). All of these patients were listed for the first time on the waiting list at status 2, and during status 1 periods they were treated with inotrops. Seven of the 34 patients died, after a mean of 1.3 periods per patient on status 1 (range 1 to 3). Five of the
From the Heart-Lung Transplant Unit, Department of Cardiothoracic Surgery, Rabin Medical Center (Beilinson Campus), Sackler Faculty of Medicine, Tel Aviv University, Petach-Tikva, Israel. Address reprint request to Dr G. Sahar, Heart-Lung Transplant Unit, Department of Cardiothoracic Surgery, Rabin Medical Center (Beilinson Campus), 49100 Petach-Tikva, Israel.
© 2001 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010 Transplantation Proceedings, 33, 2951 (2001)
0041-1345/01/$–see front matter PII S0041-1345(01)02267-9 2951