Author + information
- Received August 7, 2013
- Revision received October 17, 2013
- Accepted November 19, 2013
- Published online April 1, 2014.
- Tajinder P. Singh, MD, MSc∗,†∗ (, )
- Carly E. Milliren, MPH‡,
- Christopher S. Almond, MD, MPH∗,† and
- Dionne Graham, PhD∗,†,‡
- ∗Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- †Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- ‡Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
- ↵∗Reprint requests and correspondence:
Dr. Tajinder P. Singh, Children’s Hospital Boston, Department of Cardiology, 300 Longwood Avenue, Boston, Massachusetts 02115.
Objectives The aim of this study was to assess the survival benefit from heart transplantation (HT), defined as reduction in the risks for 90-day and 1-year mortality on undergoing HT close to listing, in candidates stratified by their risk for waiting list mortality.
Background Among patients listed for HT, those at higher risk for death without transplantation are also at higher risk for early post-transplantation mortality.
Methods All patients age ≥18 years listed for HT in the United States from 2007 to 2010 were analyzed. A model was developed to predict the risk for waiting list mortality within 90 days, and listed patients were stratified into 10 risk groups (deciles). All groups were followed for 1 year to assess cumulative 1-year mortality while on the waiting list. Models of 90-day and 1-year post-transplantation mortality were developed using recipient data, and these risks were estimated at listing in all listed candidates.
Results Of 10,159 patients listed for HT, 596 (5.9%) died within 90 days and 1,054 (10.4%) within 1 year without undergoing transplantation. Of 5,720 recipients of transplants with 1-year follow-up, 576 (10.1%) died within 1 year. The risk for death while on the waiting list within 90 days increased from 1.6% to 19% across the 10 risk groups. The survival benefit from HT increased progressively with higher risk for death without transplantation (p < 0.001 for trend), but there was no benefit in the first 6 risk groups.
Conclusions The risk for waiting list mortality varies considerably among HT candidates. Although the survival benefit of HT generally increases with increasing risk for waiting list mortality, there is no measurable benefit in many candidates at the lower end of the risk spectrum.
This study was supported by the Heart Transplant Research and Education Fund, Department of Cardiology, Boston Children’s Hospital. The work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The data were supplied by the United Network for Organ Sharing as the contractor for the Organ Procurement and Transplantation Network. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 7, 2013.
- Revision received October 17, 2013.
- Accepted November 19, 2013.
- 2014 American College of Cardiology Foundation