Long-Term Outcome in Heart Failure Patients Evaluated for Heart Transplantation But Considered Too Well

• Published in: Transplantation proceedings 2006-10, Vol.38 (8), p.2689-2690
• Main Authors: Westerlind, A., Nilsson, F., Andersson, B., Bergh, C.-H., Jeppsson, A.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Cardiology. Vascular system; Congestive/surgery; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Heart; Heart Failure; Heart Failure - surgery; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Transplantation - mortality; Heart Transplantation - physiology; Heart Transplantation/mortality/physiology; Humans; Kirurgi; Male; Medical sciences; Middle Aged; Patient Selection; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Analysis; Survivors; Tissue, organ and graft immunology; Treatment Outcome
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2006.07.038

Patients referred for heart transplantation evaluation may be accepted for transplantation, or denied due to existing contraindications or judged to be too well. There is little knowledge about long-term outcome in patients considered too well for transplantation. Ninety-five patients (mean age 47 ± 12 years, 73% men) judged “too well” at evaluation were included in this study. Acceptance for transplantation followed international guidelines. The follow-up (mean 4.5 years) was complete. Twenty of the 95 patients (21%) were eventually accepted for transplantation during the follow-up period. Twenty-one patients (22%) died, 13 without preceding acceptance for transplantation, 4 on the waiting list for transplantation, and 4 after transplantation. Cumulative and transplant-free survival at 1, 5, and 10 years were 91%, 82%, and 65%, and 90%, 70%, and 50%, respectively. In conclusion, long-term survival in patients considered too well for transplantation is better than in most contemporary series of heart transplant recipients, which suggests that the guidelines for acceptance are appropriate. However, almost one fifth of the patients die without preceding acceptance for transplantation or while on the waiting list, which illustrates the need for frequent reevaluation and tools to identify heart failure patients with an increased risk for sudden death.