Related Experiment Video
Updated: May 2, 2026
Innovative Strategies for Organ Preservation in Heart Transplantation: Uniform Cooling Preservation and Ex-situ Normothermic Perfusion
Published on: November 28, 2025
Survival in patients removed from the heart transplant waiting list before receiving a transplant
Christina VanderPluym1, Dionne A Graham2, Christopher S Almond2
1Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
Insights
One in eight patients awaiting heart transplant (HT) are removed from the list. Survival after removal depends heavily on whether it was due to clinical improvement or deterioration.
Area of Science:
- Cardiology
- Transplantation Medicine
- Outcomes Research
Background:
- Outcomes for patients removed from the heart transplant (HT) waiting list are not well understood.
- This study analyzes the outcomes of patients removed from the HT waiting list in the U.S. during the current era.
Purpose of the Study:
- To analyze the survival, relisting, and heart transplant rates of patients removed from the HT waiting list.
- To identify predictors of mortality after removal from the HT waiting list.
Main Methods:
- A cohort of patients aged 18 years or older listed for primary HT in the U.S. from July 2004 to September 2010 was identified.
- Outcomes (survival, relisting, HT) were examined for patients removed from the list by March 2011 using time-to-event analyses.
Main Results:
- Of 15,061 patients listed for HT, 12% were removed before transplant. Removal was due to clinical improvement (30%), deterioration (37%), or other reasons (33%).
- Survival after removal was high (99.6% at 30 days, 94% at 1 year) for those removed due to improvement, but significantly lower for those removed due to deterioration (44% at 30 days, 26% at 1 year).
- Clinical deterioration, specific cardiomyopathies, high UNOS status, and renal dysfunction predicted death after removal. Relisting rates were low across all removal reasons.
Conclusions:
- Approximately 12% of patients listed for HT in the U.S. are removed from the waiting list prior to transplantation.
- The reason for removal, specifically clinical deterioration versus improvement, is the most significant predictor of post-removal survival.
Background:
Little is known about the outcomes in patients who are removed from the heart transplant (HT) waiting list before receiving a transplant. We sought to analyze outcomes in such patients in the United States (U.S.) in the current era.
Methods:
All patients aged ≥ 18 years old listed for a primary HT in the U.S. between July 2004 and September 2010 were identified. Outcomes in those removed from the list by March 2011 (survival, relisting, HT) were examined using time-to-event analyses.
Results:
Of 15,061 patients listed for primary HT, 10,168 (68%) received a HT, 1,393 (9%) died on the waiting list, and 1,871(12%) were removed before receiving HT. Of patients removed from the list, 560 (30%) were removed due to clinical improvement, 692 (37%) due to deterioration, and 619 (33%) due to other reasons. After removal, 30-day and 1-year survival were 99.6% and 94%, respectively, in patients removed due to improvement and 44% and 26%, respectively, in patients removed due to deterioration. Multivariable predictors of death after removal were removal due to clinical deterioration, hypertrophic or restrictive cardiomyopathy, United Network of Organ Sharing status 1A/1B at listing, and renal dysfunction. Only 27 patients (4.8%) among those removed due to improvement, 21 (3.0%) removed due to deterioration, and 46 (7.4%) removed due to other reasons were relisted.
Conclusions:
One in 8 patients listed for HT in the U.S. are removed from the waiting list before receiving HT. The indication for removal (clinical deterioration vs improvement) is the strongest independent predictor of survival after removal from the list.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...