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Trends in patient selection for heart transplantation
S H Kubo1, S M Ormaza, G S Francis
1Department of Medicine, University of Minnesota Medical School, Minneapolis 55455.
Journal of the American College of Cardiology
|March 15, 1993
Summary
Heart transplant referrals are carefully selected, with many patients dying before evaluation or while awaiting organs. However, those deemed "too well" or improving clinically show good long-term survival.
Area of Science:
- Cardiology
- Transplantation Medicine
- Health Services Research
Background:
- Patient selection is crucial for heart transplantation success and organ allocation.
- Limited data exist on actual outcomes and the effectiveness of selection criteria in identifying suitable candidates.
Purpose of the Study:
- To review patient referral outcomes for heart transplantation.
- To assess the utility of selection criteria at a single center.
- To identify trends over a five-year period (1987-1991).
Main Methods:
- Retrospective review of 511 adult heart failure patient referrals (1987-1991).
- Follow-up to assess acceptance, rejection, death, referral elsewhere, or pending status.
Main Results:
- 43% of referrals were accepted onto the waiting list; 43% were rejected.
- 8% died before evaluation completion; 22% died while awaiting transplantation.
- Patients rejected as "too well" (23% of rejections) or removed for clinical improvement had good prognoses.
Conclusions:
- Referrals represent a high-mortality group, with significant pre-evaluation and waiting list deaths.
- Selection criteria effectively identify patients with lower mortality risk (e.g., those improving clinically).
- Donor organ shortage significantly impacted waiting list size and transplant times.