Risk of death or incapacitation after heart transplantation, with particular reference to pilots.
Pilots who have received a heart transplant may subsequently want to resume flying. This study was undertaken to determine whether a group of heart transplant recipients who had a particularly low risk of sudden unexpected death could be identified from clinical data. An event, "rapid-onset death," was defined incorporating a number of possible causes of death that could result in a heart transplant recipient-pilot losing control of an airplane. The survival of 3676 patients undergoing a first heart transplantation was 85% and 73% at 1 and 5 years, respectively, the hazard function having a high early phase of risk. When time zero was moved to the beginning of the second year after transplantation, the freedom from "rapid-onset death" at posttransplantation year 2 and posttransplantation year 5 was 96.8% and 88%, respectively. For patients who had both a "normal" coronary angiogram and no episodes of acute heart rejection during the first year transplantation, the probability of "rapid onset death" during the second posttransplantation year was 1.4%, and given the same circumstances, during the third posttransplantation year the risk of "rapid-onset death" was 1.6%. This information is potentially useful to the Federal Aviation Administration for policy decisions regarding this issue.
McGiffin
D C
DC
Department of Surgery, University of Alabama at Birmingham, 35294-0007, USA.
Naftel
D C
DC
Spann
J L
JL
Kirklin
J K
JK
Young
J B
JB
Bourge
R C
RC
Mills
R M
RM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000401:Aircraft; D002423:Cause of Death; D016208:Databases, Factual; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004185:Disability Evaluation; D006084:Graft Rejection / Q000401:mortality; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012306:Risk; D015996:Survival Rate; D014938:Work Capacity Evaluation