Does Survival on the Heart Transplant Waiting List Depend on the Underlying Heart Disease?

Area of Science:

• Cardiology and Transplant Medicine
• Outcomes Research in Cardiac Surgery

Background:

• Certain heart conditions, including restrictive cardiomyopathy (RCM), congenital heart disease (CHD), and hypertrophic cardiomyopathy (HCM), can pose challenges for patients awaiting orthotopic heart transplantation (OHT).
• These patients may have limited options for mechanical circulatory support or inotropic therapies, potentially impacting their survival while on the transplant waiting list.

Purpose of the Study:

• To investigate and compare survival rates among patients with different types of heart disease on the waiting list for orthotopic heart transplantation (OHT).
• To identify specific heart conditions associated with a higher risk of mortality prior to OHT.

Main Methods:

• Analysis of adult patients awaiting OHT between 2004 and 2014 from the Scientific Registry of Transplant Recipients database.
• Evaluation of all-cause mortality as the primary endpoint, using multivariate Cox proportional hazards modeling to assess survival differences.
• Adjustment for confounding variables including age, renal function, inotropes, mechanical ventilation, and mechanical circulatory support.

Main Results:

• A total of 14,447 patients with dilated cardiomyopathy (DCM), 823 with RCM, 11,799 with ischemic cardiomyopathy (ICM), 602 with HCM, 964 with CHD, and 584 with valvular disease were included.
• After adjusting for covariates, RCM (HR 1.70), ICM (HR 1.10), HCM (HR 1.23), valvular disease (HR 1.30), CHD (HR 1.37), and 'other' diagnoses (HR 1.51) showed increased hazard ratios for mortality relative to DCM.
• Sex was identified as a significant modifier of mortality risk for ICM, RCM, and 'other' diagnoses.

Conclusions:

• In the United States, patients with RCM, CHD, or those who have undergone prior heart transplantation face a significantly higher risk of death while awaiting OHT.
• These findings highlight the need for tailored management strategies and potentially earlier consideration for transplantation in high-risk patient groups.