RISK-FACTORS FOR EARLY DEATH IN PATIENTS AWAITING HEART-LUNG OR LUNG TRANSPLANTATION - EXPERIENCE AT A SINGLE EUROPEAN CENTER

Background. Our purpose was to establish whether patients on the waiti ng list for heart-lung or lung transplantation had different survival rates according to diagnosis and to determine the specific variables r esponsible for early death. Methods. Between 1988 and 1996, 278 patien ts were placed on the waiting list for organ transplant. Diagnoses wer e pulmonary vascular disease in 128, parenchymal disease in 141, and r etransplantation in 9 patients. Eighty patients received transplants, 100 patients died awaiting transplantation, and 98 patients are still awaiting transplantation. Univariate and multivariate analyses of risk factors for early death on the waiting list were performed. Patients still listed less than or equal to 6 months (n=24), transplanted less than or equal to 6 months (n=37), or in the retransplantation group (n =9) were excluded. Of the remaining 208 patients, 52 died less than or equal to 6 months and 156 survived >6 months. Results. Patients with primary pulmonary hypertension, pulmonary fibrosis, or cystic fibrosis had statistically significantly lower survival rates at 6, 12, and 24 months (31%, 36% and 26%, respectively, at 24 months) than patients w ith Eisenmenger's syndrome and chronic obstructive pulmonary disease ( 76% and 71%), Patients with Eisenmenger's syndrome who died less than or equal to 6 months had significantly higher systolic pulmonary arter y pressure (134+/-39 vs. 108+/-25 mmHg) and pulmonary vascular resiste nce (1928+/-1686 vs. 1191+/-730 dyn/sec/cm(-5)) than those who survive d longer. Patients with pulmonary fibrosis who died less than or equal to 6 months had significantly lower forced vital capacity (36+/-15 vs . 47+/-13% predicted), forced expiratory volume (37+/-14 vs, 48+/-14% predicted), room air pO(2), (42+/-11 vs. 50+/-11 mmHg), and room air O -2-saturation (78+/-10 vs. 84+/-8%) than those who survived longer. In the multivariate analysis, only the type of pathology was a significa nt risk factor for death after being on the waiting list less than or equal to 6 months. Conclusions. Certain pathologies and variables are risk factors for early death in patients on the waiting list. This inf ormation may be used to allocate specific donor organs to patients in greater need.