Mortality from time of listing for transplantation as an indicator of candidate outcomes

Survival after transplantation has traditionally been the statistic most closely scrutinized as to the efficacy of the procedure and a program's performance. We propose that mortality from the time of listing is a more significant outcome measure for potential transplant candidates. We present our lung transplant program's outcomes using this measure.

An analysis was performed on all patients listed for lung transplantation at our institution between 1997 and 2002. Kaplan-Meier analyses of survival at 1, 2, and 3 years after listing were assessed.

One hundred forty-eight patients qualified for the analysis; of these, 96 received transplants. The median time to transplantation was 142 days. Twenty-five of the patients died while waiting for a transplant. The median time to death for these patients was 311 days. Of the 27 transplant recipients who died, the median time from listing to death was 547 days. The 1-, 2-, and 3-year mortality rates after being listed were 20.0%, 32.4%, and 39.7%, respectively, for all patients.

Mortality after listing is a more relevant statistic for prospective transplant candidates. Intraprogram comparisons of listed nontransplant survival to listed transplant survival may facilitate the acceptance of sicker patients for transplant consideration. It may also help foster the development of an "alternate" list for transplantation and prove useful in helping determine organ prioritization.