University of Arizona, Cardiac Transplantation: changing patterns in selection and outcomes

Among 391 patients who received heart transplants at the University of Arizona since 1990, the percentage of bridge-to-transplant device patients receiving donor hearts has increased from 6.7% to 50%. Survival after transplantation in this-bridge-to transplant group and has been consistently 10-15% lower than patients who do not require a device. The result has been that our overall survival rate is beginning to fall. We have come to 2 major conclusions based on these results: First, the current UNOS system ranking candidates as Status 1A, 1B, and 2 may not identify those who are at higher risk for transplantation. It has failed to do so in our program. Rather, by grouping the potential recipients into patients with a device, Status 1 nondevice patients, and Status 2 patients, we have found a significantly lower survival rate after transplantation in the device group. This suggests that the problems shared by device patients such as being anticoagulated, having a difficult reoperation at the time of transplantation, and having increased inflammation and decreased immunity clearly place these patients in a very different risk group than other potential recipients. Second, these results lead us to believe that some high-risk device patients may not be suitable for transplantation and might be better if treated with devices as alternatives to transplantation.