Should UNOS Status 2 patients undergo transplantation?
BACKGROUND
With recent improvements in medical and device therapy, the benefit of cardiac transplantation for UNOS Status 2 patients has been questioned. No randomized trial has been performed to compare transplantation versus contemporary medical therapy.


METHODS
Between January 1996 and December 2003, 203 patients were listed at our institution for heart transplantation as UNOS Status 2. We performed a retrospective review to determine outcomes in these patients.


RESULTS
Demographics of this cohort revealed a mean age of 52 years, female sex in 28%, and ischemic etiology in 47%. Eighty-one patients (40%) had an implantable cardiac defibrillator. A total of 64 patients (32%) had to be upgraded in their UNOS status, with 9 requiring a left ventricular assist device. Of the entire group, 95 (47%) underwent transplantation at a mean time of 303 days, 45 (22%) died while waiting at a mean time of 397 days, and 24 (12%) were removed from the waiting list due to deterioration in medical condition such that transplantation was no longer an option. The remaining patients continue to wait or have been removed from consideration due to improved condition. Survival at 1- and 3-years postlisting was 94% and 87% for patients who received transplants compared to 81% and 57% for patients who did not receive transplants (P < .01).


CONCLUSIONS
A significant number of patients listed as Status 2 are upgraded in UNOS status or die while on the waiting list. Early and midterm survival is significantly better with transplantation. Identification of variables associated with deterioration may allow for better risk stratification in the future. At this point, transplantation offers the best outcome.
Moazami
Nader
N
Divisions of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA. moazamin@wustl.edu
Shah
Nirav R
NR
Ewald
Gregory A
GA
Geltman
Edward M
EM
Moorhead
Sharon L
SL
Pasque
Michael K
MK
D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome