title: Survival in patients removed from the heart transplant waiting list before receiving a transplant.
abstract: BACKGROUND
  Little is known about the outcomes in patients who are removed from the heart transplant (HT) waiting list before receiving a transplant. We sought to analyze outcomes in such patients in the United States (U.S.) in the current era.
  
  
  METHODS
  All patients aged ≥ 18 years old listed for a primary HT in the U.S. between July 2004 and September 2010 were identified. Outcomes in those removed from the list by March 2011 (survival, relisting, HT) were examined using time-to-event analyses.
  
  
  RESULTS
  Of 15,061 patients listed for primary HT, 10,168 (68%) received a HT, 1,393 (9%) died on the waiting list, and 1,871(12%) were removed before receiving HT. Of patients removed from the list, 560 (30%) were removed due to clinical improvement, 692 (37%) due to deterioration, and 619 (33%) due to other reasons. After removal, 30-day and 1-year survival were 99.6% and 94%, respectively, in patients removed due to improvement and 44% and 26%, respectively, in patients removed due to deterioration. Multivariable predictors of death after removal were removal due to clinical deterioration, hypertrophic or restrictive cardiomyopathy, United Network of Organ Sharing status 1A/1B at listing, and renal dysfunction. Only 27 patients (4.8%) among those removed due to improvement, 21 (3.0%) removed due to deterioration, and 46 (7.4%) removed due to other reasons were relisted.
  
  
  CONCLUSIONS
  One in 8 patients listed for HT in the U.S. are removed from the waiting list before receiving HT. The indication for removal (clinical deterioration vs improvement) is the strongest independent predictor of survival after removal from the list.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Christina
authors.initials: C
authors.lastname: VanderPluym
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Almond
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Blume
authors.affiliation: Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Carly E
authors.initials: CE
authors.lastname: Milliren
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. Electronic address: tp.singh@cardio.chboston.org.
authors.forename: Tajinder P
authors.initials: TP
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000453:epidemiology / Q000401:mortality*; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States; D014850:Waiting Lists; D055815:Young Adult
keywords: heart transplantation; removal; survival; waiting list