Related Experiment Videos
Should stable UNOS Status 2 patients be transplanted?
Javier Jimenez1, Leah Bennett Edwards, Robert Higgins
1University of Miami-School of Medicine, Jackson Memorial Medical Center, Miami, FL 33136, USA. JJimenez2@med.miami.edu
Summary
For advanced heart failure patients stable enough for United Network for Organ Sharing (UNOS) Status 2, cardiac transplantation showed no survival advantage at one year compared to continued medical therapy.
Area of Science:
- Cardiology
- Transplantation Medicine
- Outcomes Research
Background:
- Contemporary medical therapies have improved outcomes for advanced heart failure patients.
- This raises questions about the survival benefits of heart transplantation for stable UNOS Status 2 patients.
Purpose of the Study:
- To evaluate the survival advantage of cardiac transplantation versus medical management for patients listed as UNOS Status 2.
- To identify predictors of mortality in heart transplant candidates.
Main Methods:
- A competing risk method was used to calculate waiting list event probabilities.
- A time-dependent proportional hazards model analyzed predictors of death.
- Data from 7,539 adult heart transplant candidates listed between January 1999 and June 2001 were analyzed.
Main Results:
- Among 4,255 UNOS Status 2 patients, 48% received a transplant, 11.5% were removed, 11.4% died, and 29% remained listed.
- At 30 months post-transplant, survival rates were similar across UNOS Status 1A, 1B, and 2 groups (81%, 77%, 83%).
- One-year survival analysis showed no difference for UNOS Status 2 patients who underwent transplantation compared to those remaining on the waiting list.
Conclusions:
- Cardiac transplantation offers no one-year survival benefit for UNOS Status 2 patients in the current era of advanced heart failure therapies.
- These findings suggest a re-evaluation of UNOS Status 2 criteria may be warranted.