Results of heart transplantation in the urgent recipient--who should be transplanted?
OBJECTIVE
To evaluate immediate and long-term results of cardiac transplantation at two different levels of urgency.


METHODS
From November 2003 to December 2012, 228 patients underwent cardiac transplantation. Children and patients in cardiogenic shock were excluded from the study. From the final group (n=212), 58 patients (27%) were hospitalized under inotropic support (Group A), while 154 (73%) were awaiting transplantation at home (Group B). Patients in Group A were younger (52.0±11.3 vs. 55.2±10.4 years, P=0.050) and had shorter waiting times (29.4±43.8 vs. 48.8±45.2 days; P=0.006). No difference was found for sex or other comorbidities. Haemoglobin was lower and creatinine higher in Group A. The characteristics of the donors were similar. Follow-up was 4.5±2.7 years.


RESULTS
No differences were found in time of ischemia (89.1±37.0 vs. 91.5±34.5 min, P=0.660) or inotropic support (13.8% vs. 11.0%, P=0.579), neither in the incidence of cellular or humoral rejection and of cardiac allograft vasculopathy. De novo diabetes de novo in the first year was slightly higher in Group A (15.5% vs. 11.7%, P=0.456), and these patients were at increased risk of serious infection (22.4% vs. 12.3%, P=0.068). Hospital mortality was similar (3.4% vs. 4.5%, P=0.724), as well as long-term survival (7.8±0.5 vs. 7.4±0.3 years).


CONCLUSIONS
The results obtained in patients hospitalized under inotropic support were similar to those of patients awaiting transplantation at home. Allocation of donors to the first group does not seem to compromise the benefit of transplantation. These results may not be extensible to more critical patients.
Cardiothoracic Surgery University Hospital, Coimbra, Portugal.
David
D
Prieto
Cardiothoracic Surgery University Hospital, Coimbra, Portugal.
Pedro
P
Correia
Cardiothoracic Surgery University Hospital, Coimbra, Portugal.
Pedro
P
Antunes
Cardiothoracic Surgery University Hospital, Coimbra, Portugal.
Manuel
M
Batista
Cardiothoracic Surgery University Hospital, Coimbra, Portugal.
Manuel J
MJ
Antunes
D000328:Adult; D000368:Aged; D002423:Cause of Death; D046148:Donor Selection; D004630:Emergencies; D005260:Female; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D066027:Transplant Recipients / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality