Survival on heart transplant waiting list improved from 1987 to 2017
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Survival on heart transplant waiting lists increased over time in patients with or without ventricular assist devices, poor functional status and United Network for Organ Sharing status 1 and status 2 candidates, researchers found.
“This study is important because it allows transplant teams and leaders in the field to get an overarching view of the successes and areas for improvement in the field through past decades,” Elizabeth L. Godfrey, BS, MD candidate at Baylor College of Medicine, told Healio. “Identifying that waiting list survival is increasing over time encourages continued monitoring and assessment of the best timing and patient selection for offering donor hearts.”
Patients wait-listed for heart transplantation
In this retrospective cross-sectional study published in JAMA Cardiology, Syed Shahyan Bakhtiyar, MBBS, researcher in the department of surgery at Baylor College of Medicine when conducting the study and is now a general surgery resident at Johns Hopkins Hospital, and colleagues analyzed data from 95,323 patients (mean age, 52 years; 76.5% men) from the United Network for Organ Sharing database who were wait-listed for heart transplantation from 1987 to 2017. Patients were followed up from the time of wait-listing to transplantation, death or removal from the list for clinical improvement. The primary outcome variable for this study was death on the waiting list.
Survival at 1 year for patients still on the waiting list increased from 34.1% in 1987-1990 to 67.8% in 2011-2017 (difference in proportions, 0.34%; 95% CI, 0.32-0.36; P < .001).
One-year survival on the waiting list for patients with ventricular assist devices increased from 10.2% in 1996-2000 to 70% in 2011-2017 (difference in proportions, 0.6%; 95% CI, 0.58-0.62; P < .001). Increases during these periods were similar for patients without ventricular assist devices (53.9% to 66.5%; difference in proportions, 0.13%; 95% CI, 0.12-0.14; P < .001).
Waiting list survival in the decade before the 2006 United Network for Organ Sharing allocation policy was 51.1%, which increased to 63.9% the decade after it was implemented (difference in proportions, 0.13%; 95% CI, 0.12-0.14; P < .001).
Adjusted analyses determined that marked decreases in waiting list mortality occurred in each period after 1987-1990.
Different meaning to survival
“It calls to attention the fact that living on the heart transplant waiting list means something different for patients today than it did in 1987, as even an overall older, sicker patient population is living longer while listed,” Godfrey told Healio.
She added that more research is needed in this area. “Further research includes continuing this kind of large, longitudinal analysis, as the donor heart allocation policy was changed in 2018 and assessment of the impact of those changes is key. Other research would focus on what is driving the increased survival on the waiting list, and might attempt to tease out the contribution of clinical factors and management vs. changed administrative and listing practices,” Godfrey said.
For more information:
Elizabeth L. Godfrey, BS, can be reached at elizabeth.godfrey@bcm.edu.
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