Alternate waiting list strategies for heart transplantation maximize donor organ utilization.
BACKGROUND
Alternate waiting list strategies have been promoted as a means to offer the benefit of heart transplantation to a greater number of candidates. We undertook the current study to evaluate our experience with transplantation in alternate list (AL) candidates.


METHODS
Adults undergoing heart transplantation from January 1, 2001, through April 15, 2004, were evaluated. Selected patients who did not meet criteria for standard listing for heart transplantation were offered alternate listing. Primary posttransplant outcomes included 30-day, 90-day, and more than 90-day mortality, and determinants of perioperative morbidity.


RESULTS
Thirty-seven patients (14.3%) met alternate list criteria. Among these alternate list patients, contraindications to standard listing included age greater than 65 years, amyloidosis, severe diabetes mellitus and peripheral vascular disease, human immunodeficiency virus, and high-risk retransplant. The average age of alternate list donors was 41.2 +/- 13.9 years. Survival analysis revealed no posttransplant survival advantage for standard list recipients However, mean ventilatory support time was significantly (p < 0.001) longer in the alternate list group (5.7 +/- 9.3 days) compared with the standard group (2.3 +/- 4.2 days), and significantly more sternal wound infections (p = 0.03) were observed in the alternate list group (6 [16.2%]) compared with the standard group (13 [5.9%]).


CONCLUSIONS
The alternate list patients demonstrated comparable survival with standard list patients, but did exhibit more ventilatory dependence and sternal wound infections. More than half of alternate list donor organs in the future could be considered for standard list candidates as well. Use of the alternate list reinforces the assertion that, even today, our donor criteria remain too stringent.
Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA. jmc23@columbia.edu
Jonathan M
JM
Chen
Mark J
MJ
Russo
Kim M
KM
Hammond
Donna M
DM
Mancini
Aftab R
AR
Kherani
Jen M
JM
Fal
Pamela A
PA
Mazzeo
Sean P
SP
Pinney
Niloo M
NM
Edwards
Yoshifumi
Y
Naka
D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016019:Survival Analysis; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014850:Waiting Lists