REGIONAL VARIATIONS IN REFERRAL FOR HEART -TRANSPLANT

Although cardiac transplantation is a well established means of treati ng end-stage heart disease, only selected patients receive this therap y. The aim of this study was, therefore, to investigate the frequency of referrals for and performed cardiac transplantations and to assess the prognosis of patients from the different regions of German-speakin g Switzerland. From the beginning of 1989 to October 1995, 401 patient s, aged 49 +/- 12 years, were referred to the University Hospital Zuri ch for evaluation of the possibility of cardiac transplantation. 149 ( 37%) of them were transplanted. Transplanted patients had greater card iac impairment than those who were not transplanted. There were no dif ferences in age or underlying diseases. More patients from the southea stern part of Switzerland were referred than from the north-eastern pa rt. In contrast to this, the frequency of transplanted patients was si milar in all parts of Switzerland. Survival rate was not related to th e origin of transplanted patients (1-year survival 80%, 5-year surviva l 73%) whereas overall survival in patients who were not transplanted was significantly worse (1-year survival 64%, 5-year survival 45%) and differed between the various parts of our catchment area. Patients fr om regions with a high referral rate had better survival. Patients who lived in or near big cities were less frequently referred and had wor se survival. Also, survival was related to the number of followup cont rols in the specialized clinic for heart failure and heart transplanta tion. In 1989 and 1994, years in which more than 30 patients were tran splanted at our institute, only 4 of 69 (5.8%) died while waiting for transplantation, whereas during the other years 25 of 132 (18.9%) died (odds ratio 0.26; p = 0.01). Moreover, the time from listing to trans plantation was significantly shorter in 1989 and 1994 (50 +/- 66 vs. 9 5 +/- 134 days, p = 0.001). Conclusions: Patients from the different p arts of our catchment area were not equally referred for heart transpl antation. The better survival of non-transplanted patients from region s with a high referral rate suggests that the possibility of transplan tation is taken into account earlier and more frequently. Follow-up co ntrols of these patients in a specialized centre seem to be useful sin ce these patients have a better outcome. Nevertheless, the recruitment of donors remains the unsolved problem.