Mortality remains high for outpatient transplant candidates with prolonged(> 6 months) waiting list time

OBJECTIVES The study aimed to determine the risk of death or urgent transpl ant for patients who survived an initial 6 months on the outpatient heart t ransplant waiting list when criteria emphasizing reduced peak oxygen consum ption are used for transplant candidate selection. BACKGROUND Waiting time is a key criterion for heart donor allocation. A re cent single-center investigation described decreasing survival benefit from transplant for patients who survived an initial 6 months on the outpatient waiting list. METHODS Kaplan-Meier survival analyses were performed for 80 patients from the: Hospital of the University of Pennsylvania (HUP) listed from July 1986 to January 1991, and 132 patients from Columbia-Presbyterian Medical Cente r (CPMC) listed from September 1993 to September 1995. Survival from the ti me of outpatient listing for the entire group (ALL) was compared to subsequ ent survival from 6 months onward for those patients who survived the initi al 6 months after placement on the outpatient list (6M). Both urgent transp lant and left ventricular assist device implantation were considered equiva lent to death; elective transplant was censored. RESULTS Survival for 6M was not significantly better than ALL at HUP (subse quent 12 months: 60 +/- 7 vs. 60 +/- 6% [mean +/- SD]; p = 0.89) nor at CPM C (subsequent 12 months: 60 +/- 6 a. 48 +/- 5%; p = 0.35). Survival for 6M at both centers was substantially lower than survival following transplant from the outpatient list in the United States in 1995. CONCLUSIONS When high-risk patients are selected for nonurgent transplant l isting, mortality remains high, even among those who survive the initial si x months after listing. Time accrued on the waiting lst remains an appropri ate criterion for donor allocation. (C) 1999 by the American College of Car diology.