Long-term follow-up of patients eligible, deferred, or ineligible for heart transplantation

When a patient is referred to a heart transplantation center, the patient and the physician should know the predicted long-term survival according to the first transplant committee decision. The aim of the study was to describe the follow-up of patients with heart failure referred to a heart transplantation center according to the initial decision to include (eligible), exclude (ineligible), or postpone (deferred) cardiac transplantation.

The study cohort consisted of 852 consecutive patients. Univariate and trend analyses were performed by classification of data into tertiles according to the date of the first visit. The Kaplan-Meier method was used to assess overall survival and probability of receiving a transplant. The Cox hazard model was used to identify predictors of survival.

Transplantation incidence in the 3 groups (eligible, deferred, and ineligible) was 60%, 19%, and 5%, respectively. The 1-, 3-, 5-, and 10-year survival rates were 74%, 58%, 49%, and 37% among eligible patients; 87%, 72%, 62%, and 45% among deferred; and 69%, 50%, 39%, and 19% among ineligible patients (p < 0.001). The 10-year survival was 65% for eligible patients who received the transplant and 8.8% for eligible patients who did not receive the transplant. Transplantation was the most powerful predictor of survival.

The initial decision identified 3 groups of patients with different survival rates. Heart transplantation increases the survival of eligible patients at a rate similar to that of less sick subjects for whom heart transplantation can be deferred.