title: Influence of intensified medical treatment and organ allocation on outcome of transplant candidates.
abstract: BACKGROUND
  To test how the organization of a pre-transplant clinic and changes in organ allocation modus influence the survival of potential transplant candidates, the survival of patients referred for transplant evaluation between 4/93 and 4/96 (group A) was compared to that of patients referred from 5/96 to 7/00(group B).
  
  
  METHODS
  After screening for transplant indication, group A was followed by the referring physician up to transplantation or 3-month reevaluation. Group B was closely followed by a specialized heart-failure clinic. Group A was transplanted according to Eurotransplant criteria, with waiting time being the strongest priority criterion. Due to an allocation partnership off our transplant centers, group B could be transplanted according to medical urgency regardless of waiting time.
  
  
  RESULTS
  Overall one-year survival after referral was 69.8% for group A vs. 91 %for group B (p <0.0001). Transplantation within 1 year was required in more group A than group B patients (34% vs. 23%)with worse one-year post-transplant survival in group A (82%vs. 93%).
  
  
  CONCLUSIONS
  Intensified treatment by a specialized heart failure program and an allocation system that allows for preferred transplantation of the 'sickest' patient improved over-all survival of transplant candidates and reduced the percentage of patients requiring transplantation.
authors.affiliation: Herz- und Gefässchirurgie, Universitätsklinikum Kiel, Germany. jaeckle@kielheart.uni-kiel.de
authors.forename: A
authors.initials: A
authors.lastname: Costard-Jäckle
authors.forename: S W
authors.initials: SW
authors.lastname: Hirt
authors.forename: B
authors.initials: B
authors.lastname: Fischer
authors.forename: U
authors.initials: U
authors.lastname: Först
authors.forename: F
authors.initials: F
authors.lastname: Möller
authors.forename: J
authors.initials: J
authors.lastname: Cremer
mesh_terms: D000554:Ambulatory Care Facilities; D005858:Germany / Q000453:epidemiology; D015276:Health Care Rationing / Q000458:organization & administration* / Q000639:trends; D006333:Heart Failure / Q000188:drug therapy* / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D012017:Referral and Consultation; D015996:Survival Rate; D009927:Tissue and Organ Procurement / Q000458:organization & administration* / Q000639:trends; D016896:Treatment Outcome