Related Experiment Video
Updated: Aug 6, 2026
Cervical Heterotopic Mouse Heart Transplantation using End-to-side Anastomosis Technique to Study Transplant Immunology
Published on: July 3, 2026
Risk Analysis of Waiting-List Mortality in Heart Transplantation: A Multicenter Study in Korea
Jung-Hwan Kim1, Yang Hyun Cho2, Suk Ho Sohn3
1Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Insights
Heart transplant waiting list mortality is high for patients needing ECMO or with advanced disease. Risk factors include specific heart conditions, low hemoglobin, arrhythmias, and high MELD-XI scores.
Area of Science:
- Cardiology
- Transplantation Medicine
- Critical Care
Background:
- Limited national data exists on heart transplantation (HT) waiting list mortality in Korea.
- Understanding waiting list outcomes is crucial for improving patient management.
Purpose of the Study:
- To investigate heart transplantation waiting list mortality in Korea.
- To identify associated risk factors for mortality on the HT waiting list.
Main Methods:
- Retrospective analysis of 1101 patients wait-listed for HT between 2012-2017 across four centers.
- Defined waiting list time from listing to HT, death, or recovery.
- Censored subjects at transplantation or recovery.
Main Results:
- 29.7% required mechanical circulatory support (MCS), including extracorporeal membrane oxygenation (ECMO) or ventricular assist device (VAD).
- ECMO-bridged patients had significantly lower survival rates than VAD-bridged or non-MCS patients.
- Independent risk factors for mortality included congenital heart disease, restrictive cardiomyopathy, status 0, low hemoglobin, ventricular arrhythmia, high MELD-XI score, and ECMO bridging.
Conclusions:
- ECMO bridging and status 0 are associated with significantly higher waiting list mortality.
- Advanced end-organ damage at listing is an independent risk factor for waiting list mortality.
Purpose:
There are few national studies of waiting-list mortality for heart transplantation (HT) in Korea. Our multicenter study examined mortality on the HT waiting list and its associated risk factors.
Materials And Methods:
We retrospectively analyzed 1101 consecutive patients who were wait-listed for HT between 2012 and 2017 in four centers. Time on the HT waiting list was defined as the time from initial wait-listing to delisting due to HT, death, or recovery. Subjects were censored at the time of transplantation or recovery.
Results:
Of the whole cohort, 327 (29.7%) patients needed mechanical circulatory support (MCS) while on the waiting list, 314 (28.5%) were treated with extracorporeal membrane oxygenation (ECMO) as a bridge, and 13 (1.2%) were treated with a ventricular assist device (VAD) as a bridge. The waiting-list survival rate for ECMO-bridged patients was significantly lower than that for VAD-bridged or non-MCS-bridged patients. The waiting-list survival rate for patients with a status of 0 or 1 was significantly lower than for patients with a status of 2 or 3. Multivariate analysis revealed that the independent risk factors for waiting-list mortality were congenital heart disease and restrictive cardiomyopathy compared with dilated cardiomyopathy, status 0 compared with status 2 and 3, low hemoglobin, history of ventricular arrhythmia, high MELD-XI score, and ECMO bridging during the waiting period.
Conclusion:
This study showed that ECMO as a bridge to transplantation and status 0 were associated with significantly higher waiting-list mortality. Advanced end-organ damage at the time of listing was also found to be an independent risk factor for waiting-list mortality.
