PROGNOSIS OF PATIENTS WITH SEVERE CONGESTIVE-HEART-FAILURE REFERRED TO THE CARDIAC TRANSPLANT PROGRAM

In any program for cardiac transplantation, appropriate recipient sele ction is critically important. The purpose of this study is to evaluat e the prognosis of 42 patients with severe cardiac dysfunction who wer e referred to the Patient Referral Committee of the Osaka University C ardiac Transplant Program from August 1990 to July 1993. All of the pa tient profiles and clinical data were presented and discussed in the C ommittee Conference. The Committee classified the patients into three groups according to the. following criteria: Class A; 14 patients judg ed to have a medical indication for heart transplantation, Class B; 7 patients with possible indications which required reevaluation for a d efinite indication after further intensive medical treatments, and Cla ss C; 21 patients who did not have indications for heart transplantati on or who required further clinical examinations and/or medical treatm ents before a final judgment. Twelve of the 14 Class A patients had a history of NYHA functional class IV and ejection fractions were 25% or less in all of the patients but one (18.5+/-1.7%). Six patients in Cl ass A had a history of ventricular tachycardia. The one-year survival rate of Class A patients was 60%, and only 28% survived for 28 months. One patient underwent successful heart transplantation in the United States. If we assume that this patient would have died within a year w ithout heart transplantation, the estimated one-year survival rate wou ld fall to 48%, which is comparable to the survival rate of patients w ho have been accepted for transplant, but are being treated medically, in Western countries. This indicates that our criteria for recipient selection are comparable to those currently used in the Western countr ies, and therefore may be appropriate for future heart transplantation in Japan.