Survival benefit from transplantation in patients listed for heart transplantation in the United States.
OBJECTIVE
The aim of this study was to assess the survival benefit from heart transplantation (HT), defined as reduction in the risks for 90-day and 1-year mortality on undergoing HT close to listing, in candidates stratified by their risk for waiting list mortality.


BACKGROUND
Among patients listed for HT, those at higher risk for death without transplantation are also at higher risk for early post-transplantation mortality.


METHODS
All patients age ≥18 years listed for HT in the United States from 2007 to 2010 were analyzed. A model was developed to predict the risk for waiting list mortality within 90 days, and listed patients were stratified into 10 risk groups (deciles). All groups were followed for 1 year to assess cumulative 1-year mortality while on the waiting list. Models of 90-day and 1-year post-transplantation mortality were developed using recipient data, and these risks were estimated at listing in all listed candidates.


RESULTS
Of 10,159 patients listed for HT, 596 (5.9%) died within 90 days and 1,054 (10.4%) within 1 year without undergoing transplantation. Of 5,720 recipients of transplants with 1-year follow-up, 576 (10.1%) died within 1 year. The risk for death while on the waiting list within 90 days increased from 1.6% to 19% across the 10 risk groups. The survival benefit from HT increased progressively with higher risk for death without transplantation (p < 0.001 for trend), but there was no benefit in the first 6 risk groups.


CONCLUSIONS
The risk for waiting list mortality varies considerably among HT candidates. Although the survival benefit of HT generally increases with increasing risk for waiting list mortality, there is no measurable benefit in many candidates at the lower end of the risk spectrum.
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. Electronic address: tp.singh@cardio.chboston.org.
Tajinder P
TP
Singh
Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
Carly E
CE
Milliren
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Christopher S
CS
Almond
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
Dionne
D
Graham
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D009202:Cardiomyopathies / Q000401:mortality / Q000601:surgery; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D007674:Kidney Diseases / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D018570:Risk Assessment; D014481:United States; D014850:Waiting Lists / Q000401:mortality*; D055815:Young Adult
heart failure; heart transplantation; risk stratification; survival