The Eurotransplant High-Urgency Heart Transplantation Program: an option for patients in acute heart failure?
OBJECTIVE
The Eurotransplant High-Urgency (HU) Heart Transplantation Program allows urgent heart transplants to be carried out in rapidly deteriorating patients with acute-to-chronic heart failure on the elective waiting list. But do the results of HU heart transplantation justify performing primary heart transplantation in these critically ill patients and offer an acceptable outcome?


METHODS
Between 2000 and 2004, 64 heart transplantations (HTx) (32 elective and 32 HU-HTx) were performed in our department. After having been accepted in an auditing process based on HU criteria, intensive care patients in NYHA functional class IV (cardiac index 1.7 l/min/qm BS), in end-organ failure (creatinine 1.5 mg/dl), and with catecholamine dependence (dobutamine 8 microg/kg/min), are given priority with respect to organ allocation, and their data were compared to data from elective patients from the same period.


RESULTS
HU requests were accepted in 97 % of cases. Two requests were not accepted, and both patients with contraindications for assist device implantation died within one week. The HU patients were 100 % in NYHA class IV, 93 % of the elective patients were in NYHA class III. Waiting time on the HU list was 13 days, and 7 of these patients died before HTx. Following heart transplantation, survival rates at 30 days and at one year of the HU group were 88 % and 85 % versus 94 % and 93 % in the elective group.


CONCLUSIONS
This study shows that end-stage heart failure patients in the HU program can be transplanted primarily with good results if an organ is available in time. We are still in the position where the HU program only manages the organ shortage; there are still too many patients on the waiting list who die before receiving a donor organ.
Koch
A
A
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany. Achim_Koch@med.uni-heidelberg.de
Tochtermann
U
U
Remppis
A
A
Dengler
T J
TJ
Schnabel
P A
PA
Hagl
S
S
Sack
F U
FU
D000208:Acute Disease; D000328:Adult; D004630:Emergencies; D005060:Europe; D005260:Female; D005858:Germany; D015276:Health Care Rationing; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D016019:Survival Analysis; D014850:Waiting Lists