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Improved survival of patients with end-stage heart failure listed for heart transplantation: analysis of organ procurement and transplantation network/U.S. United Network of Organ Sharing data, 1990 to 2005.
J Am Coll Cardiol. 2007 Sep 25; 50(13):1282-90.JACC

Abstract

OBJECTIVES

We sought to investigate the actual survival of patients with end-stage heart failure listed for heart transplantation (HT) in the U.S.

BACKGROUND

The United Network of Organ Sharing (UNOS) reported that the mortality rates on the U.S. HT waiting list have been gradually declining. This suggests that the survival of these patients may have improved.

METHODS

The survival censored on the day of HT or removal from the waiting list was calculated for 18,004 UNOS status 1 and 30,978 status 2 candidates listed in eras I (1990 to 1994), II (1995 to 1999), and III (2000 to 2005) in the U.S. The Cox proportional model was employed for multivariable analysis.

RESULTS

The 1-year survival on the HT waiting list improved from 49.5% to 69.0% for status 1 and from 81.8% to 89.4% for status 2 candidates between eras I and III. The predictors of death within 2 months from listing of status 1 candidates included UNOS status 1A, mechanical ventilation, inotropic and intra-aortic balloon pump support, pulmonary capillary wedge pressure >20 mm Hg and serum creatinine >1.5 mg/dl, failed HT, valvular cardiomyopathy, age >60 years, Caucasian ethnicity, and weight < or =70 kg, as well as the lack of intracardiac cardioverter-defibrillator on the day of listing.

CONCLUSIONS

Survival of HT candidates on the waiting list has significantly improved. Survival of status 1 candidates continues to depend on urgent HT. Predictors of 2-month mortality may help identify status 1 candidates who warrant the highest priority for HT and/or mechanical circulatory support. The 1-year survival of status 2 candidates approaches outcomes of HT, thus raising the question of whether early listing of some of these patients is justified.

Authors+Show Affiliations

Cardiovascular Division, Georgetown University, Washington Hospital Center, Washington, DC, USA. KL2384@columbia.eduNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

17888847

Citation

Lietz, Katherine, and Leslie W. Miller. "Improved Survival of Patients With End-stage Heart Failure Listed for Heart Transplantation: Analysis of Organ Procurement and Transplantation network/U.S. United Network of Organ Sharing Data, 1990 to 2005." Journal of the American College of Cardiology, vol. 50, no. 13, 2007, pp. 1282-90.
Lietz K, Miller LW. Improved survival of patients with end-stage heart failure listed for heart transplantation: analysis of organ procurement and transplantation network/U.S. United Network of Organ Sharing data, 1990 to 2005. J Am Coll Cardiol. 2007;50(13):1282-90.
Lietz, K., & Miller, L. W. (2007). Improved survival of patients with end-stage heart failure listed for heart transplantation: analysis of organ procurement and transplantation network/U.S. United Network of Organ Sharing data, 1990 to 2005. Journal of the American College of Cardiology, 50(13), 1282-90.
Lietz K, Miller LW. Improved Survival of Patients With End-stage Heart Failure Listed for Heart Transplantation: Analysis of Organ Procurement and Transplantation network/U.S. United Network of Organ Sharing Data, 1990 to 2005. J Am Coll Cardiol. 2007 Sep 25;50(13):1282-90. PubMed PMID: 17888847.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved survival of patients with end-stage heart failure listed for heart transplantation: analysis of organ procurement and transplantation network/U.S. United Network of Organ Sharing data, 1990 to 2005. AU - Lietz,Katherine, AU - Miller,Leslie W, Y1 - 2007/08/16/ PY - 2007/03/12/received PY - 2007/04/16/revised PY - 2007/04/30/accepted PY - 2007/9/25/pubmed PY - 2007/10/13/medline PY - 2007/9/25/entrez SP - 1282 EP - 90 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 50 IS - 13 N2 - OBJECTIVES: We sought to investigate the actual survival of patients with end-stage heart failure listed for heart transplantation (HT) in the U.S. BACKGROUND: The United Network of Organ Sharing (UNOS) reported that the mortality rates on the U.S. HT waiting list have been gradually declining. This suggests that the survival of these patients may have improved. METHODS: The survival censored on the day of HT or removal from the waiting list was calculated for 18,004 UNOS status 1 and 30,978 status 2 candidates listed in eras I (1990 to 1994), II (1995 to 1999), and III (2000 to 2005) in the U.S. The Cox proportional model was employed for multivariable analysis. RESULTS: The 1-year survival on the HT waiting list improved from 49.5% to 69.0% for status 1 and from 81.8% to 89.4% for status 2 candidates between eras I and III. The predictors of death within 2 months from listing of status 1 candidates included UNOS status 1A, mechanical ventilation, inotropic and intra-aortic balloon pump support, pulmonary capillary wedge pressure >20 mm Hg and serum creatinine >1.5 mg/dl, failed HT, valvular cardiomyopathy, age >60 years, Caucasian ethnicity, and weight < or =70 kg, as well as the lack of intracardiac cardioverter-defibrillator on the day of listing. CONCLUSIONS: Survival of HT candidates on the waiting list has significantly improved. Survival of status 1 candidates continues to depend on urgent HT. Predictors of 2-month mortality may help identify status 1 candidates who warrant the highest priority for HT and/or mechanical circulatory support. The 1-year survival of status 2 candidates approaches outcomes of HT, thus raising the question of whether early listing of some of these patients is justified. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/17888847/Improved_survival_of_patients_with_end_stage_heart_failure_listed_for_heart_transplantation:_analysis_of_organ_procurement_and_transplantation_network/U_S__United_Network_of_Organ_Sharing_data_1990_to_2005_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)02297-8 DB - PRIME DP - Unbound Medicine ER -