title: Effect of receiving a heart transplant: analysis of a national cohort entered on to a waiting list, stratified by heart failure severity. Comparative Outcome and Clinical Profiles in Transplantation (COCPIT) Study Group.
abstract: OBJECTIVE
  To determine whether there is a survival benefit associated with cardiac transplantation in Germany.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  All 889 adult patients listed for a first heart transplant in Germany in 1997.
  
  
  METHODS
  Mortality, stratified by heart failure severity.
  
  
  RESULTS
  Within 1 year after listing, patients with a predicted high risk had the highest global death rate (51% v 32% and 29% for medium and low risk patients respectively; P<0.0001), had the highest risk of dying on the waiting list (32% v 20% and 20%; P=0.0003), and were more likely to receive a transplant (48% v 45% and 41%; P=0.01). Differences between the risk groups in outcome after transplantation did not reach significance (P=0.2). Transplantation was not associated with a reduction in mortality risk for the total cohort, but it did provide a survival benefit for the high risk group.
  
  
  CONCLUSIONS
  Cardiac transplantation in Germany is currently associated with a survival benefit only in patients with a predicted high risk of dying on the waiting list. Patients with a predicted low or medium risk have no reduction in mortality risk associated with transplantation; they should be managed with organ saving approaches rather than transplantation.
authors.affiliation: Department of Cardiothoracic Surgery, Muenster University, D-48129 Muenster, Germany. md785@columbia.edu
authors.forename: M C
authors.initials: MC
authors.lastname: Deng
authors.forename: J M
authors.initials: JM
authors.lastname: De Meester
authors.forename: J M
authors.initials: JM
authors.lastname: Smits
authors.forename: J
authors.initials: J
authors.lastname: Heinecke
authors.forename: H H
authors.initials: HH
authors.lastname: Scheld
mesh_terms: D000208:Acute Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012306:Risk; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014850:Waiting Lists