CLINICAL STATUS OF PATIENTS REMOVED FROM A TRANSPLANT WAITING LIST RIVALS THAT OF TRANSPLANT RECIPIENTS AT SIGNIFICANT COST SAVINGS

We retrospectively contrasted the medical outcome of patients removed from the heart transplant consideration list because of clinical impro vement with that of transplant recipients. Of 60 patients awaiting tra nsplantation, 18 were removed from the list (group A), and 42 required transplant or died (group a). Group A significantly improved regardin g exercise oxygen uptake, ejection fraction, and hemodynamics. For mor e than 2 years after transplantation or ''delisting,'' both groups had comparable symptoms (New York Heart Association class I to II) and ca rdiovascular mortality (1 of 18 for group A vs 3 of 32 for group B) bu t lower hospitalizations for group A (0.5 +/- 0.6 of 27 months per pat ient) versus group a (2.8 +/- 2.1 of 23 months per patient) (p=0.0002) . Despite two patients who had been removed from the list requiring tr ansplantation, savings for delisting exceeded $2.2 million. Thus medic al therapy allows transplant recipient list removal with clinical impr ovements sustained for 1 to 3 years at significant cost savings.