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Multivariate analysis of factors affecting waiting time to heart transplantation
J M Chen1, A D Weinberg, E A Rose
1Department of Surgery, Columbia-Presbyterian Medical Center, New York, NY 10032, USA.
Insights
Heart transplant waiting times are significantly impacted by United Network for Organ Sharing (UNOS) status, blood type, and patient weight. Lower weight and blood type AB predict shorter waits for heart transplantation.
Area of Science:
- Cardiology
- Transplant Surgery
- Medical Statistics
Background:
- Cardiac transplantation success has increased patient demand.
- Limited donor organs lead to longer waiting times and increased mortality.
- Identifying factors influencing waiting time is crucial for patient management.
Purpose of the Study:
- To analyze factors affecting heart transplant waiting times.
- To identify predictors of shorter or longer waiting periods.
- To inform strategies for managing patients on the transplant waiting list.
Main Methods:
- Univariate and multivariate analyses were conducted on 301 heart transplant candidates.
- Cox proportional hazards model was used to assess multiple variables.
- Variables included age, sex, race, blood type, weight, and UNOS status.
Main Results:
- Mean waiting time was 170.2 days (median 103.5 days).
- UNOS status, blood type, and weight significantly impacted waiting time.
- Lower weight at listing and blood type AB were associated with shorter waiting times.
Conclusions:
- UNOS status, blood type, and weight are key determinants of heart transplant waiting time.
- Findings may help identify high-risk patients who could benefit from surgical alternatives.
- Accurate prediction of waiting time is essential for optimizing transplant candidate care.
Background:
The growing clinical success of cardiac transplantation has resulted in a dramatic increase in the number of patients referred and subsequently listed for cardiac transplantation. Paradoxically, in the presence of a limited donor organ pool, such expansion has increased both the waiting time for transplantation and the number of patients dying while on the waiting list.
Methods:
We performed univariate and multivariate analyses of the waiting times of 301 patients listed for transplantation using a Cox proportional hazards model to evaluate the simultaneous effect of multiple variables on the waiting time of heart transplant candidates. Variables considered included age, sex, race, blood type, weight at listing, United Network for Organ Sharing (UNOS) status at listing, UNOS status at transplantation, and proportion of time on the waiting list as UNOS status 1.
Results:
The mean waiting time for patients ultimately having transplantation was 170.2 +/- 206.0 days; the median waiting time was 103.5 days. Age, sex, weight, blood type, and percent of time as UNOS status 1 all had a significant impact on waiting time in the univariate analysis. By multivariate analysis, proportion of time as UNOS status 1, lower weight at listing, and blood type AB were all highly associated as predictors of a shorter waiting time. Weight at listing represented a continuous variable whose risk ratio for a shorter waiting time correlated in such a way that the risk of a longer waiting time increased 2.3 per 22.5-kg (50-pound) increase in weight. Blood types A and B, although associated with a shorter waiting time, correlated less strongly than the other three variables.
Conclusions:
Our findings from this multivariate analysis demonstrate that UNOS status, blood type, and weight were the variables that most strongly affected overall waiting time for transplantation. It is our hope to define more accurately a group of patients with both a high likelihood of a long waiting time and a prohibitive risk of death while on the waiting list, who therefore may benefit from surgical alternatives to transplantation.