Should stable UNOS Status 2 patients be transplanted?
BACKGROUND
Improved outcomes with contemporary medical therapy in patients with advanced heart failure brings into question the survival advantage of transplantation for patients in stable United Network for Organ Sharing (UNOS) Status 2.


METHODS
Between January 1999 and June 2001, a total of 7,539 adult patients were listed for heart transplantation. Of those, 4,255 (56.4%) patients were listed as UNOS Status 2. Using a competing risk method, we computed probabilities of events while on the waiting list. Additionally, we used a time-dependent proportional hazards model to determine predictors of death before and after transplantation.


RESULTS
Demographics included age >60 (72%), female sex (23%), ischemic causes for transplantation (49%), white race (85%), and median time on the waiting list (544 days). Laboratory and hemodynamic values included mean serum albumin of 3.9 g/dl, serum creatinine of 1.4 mg/dl, mean pulmonary artery pressure of 28 mm Hg, mean pulmonary capillary wedge pressure of 19 mm Hg, and mean cardiac output of 4.5 liter/min. Final outcomes on the waiting list for patients initially listed as UNOS Status 2 were transplantation (48%), removal from the list (11.5%), death (11.4%), and continued listing (29%). At 30 months after transplantation, survival was 81% for patients undergoing transplantation as Status 1A, 77% as Status 1B, and 83% as Status 2, and showed no difference among groups. At 365 days, survival analysis showed no difference for patients listed and undergoing transplantation as UNOS Status 2 compared with those still waiting as Status 2.


CONCLUSIONS
In the current era of advances in medical and surgical therapies for heart failure, we found no survival benefit of cardiac transplantation at 1 year for patients initially listed as UNOS Status 2.
Jimenez
Javier
J
University of Miami-School of Medicine, Jackson Memorial Medical Center, Miami, FL 33136, USA. JJimenez2@med.miami.edu
Bennett Edwards
Leah
L
Higgins
Robert
R
Bauerlein
Joseph
J
Pham
Si
S
Mallon
Stephen
S
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002302:Cardiac Output; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011669:Pulmonary Wedge Pressure; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D016019:Survival Analysis; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014850:Waiting Lists
D015415:Biomarkers; D012709:Serum Albumin; D003404:Creatinine