title: Severe right ventricular dysfunction is an independent predictor of pre- and post-transplant mortality among candidates for heart transplantation.
abstract: BACKGROUND
  Heart transplantation is the gold-standard treatment for end-stage heart failure. However, the shortage of grafts has led to longer waiting times and increased mortality for candidates without priority.
  
  
  OBJECTIVE
  To study waiting-list and post-transplant mortality, and their risk factors among patients registered for heart transplantation without initial high emergency procedure.
  
  
  METHODS
  All patients registered on the heart transplantation waiting list (2004-2015) without initial high emergency procedure were included. Clinical, biological, echocardiographic and haemodynamic data were collected. Waiting list and 1-year post-transplant survival were analysed with a Kaplan-Meier model.
  
  
  RESULTS
  Of 221 patients enrolled, 168 (76.0%) were men. Mean age was 50.0±12.0 years. Forty-seven patients died on the waiting list, resulting in mortality rates of 11.2±2.7% at 1 year, 31.9±5.4% at 2 years and 49.4±7.1% at 3 years. Median survival was 36.0±4.6 months. In the multivariable analysis, left ventricular ejection fraction<30% (hazard ratio [HR]: 3.76, 95% confidence interval [CI]: 1.38-10.24; P=0.010) and severe right ventricular systolic dysfunction (HR: 2.89, 95% CI: 1.41-5.92; P=0.004) were associated with increased waiting-list mortality. The post-transplant survival rate was 73.1±4.4% at 1 year. Pretransplant severe right ventricular dysfunction and age>50 years were strong predictors of death after transplantation (HR: 5.38, 95% CI: 1.38-10.24 [P=0.020] and HR: 6.16, 95% CI: 1.62-9.32 [P=0.0130], respectively).
  
  
  CONCLUSIONS
  Mortality among candidates for heart transplantation remains high. Patients at highest risk of waiting-list mortality have to be promoted, but without compromising post-transplant outcomes. For this reason, candidates with severe right ventricular dysfunction are of concern, because, for them, transplantation is hazardous.
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France.
authors.forename: Eleonore
authors.initials: E
authors.lastname: Ravis
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France. Electronic address: alexis.theron@ap-hm.fr.
authors.forename: Alexis
authors.initials: A
authors.lastname: Theron
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, La Timone Hospital, 13005 Marseille, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Mancini
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jaussaud
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Morera
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Chalvignac
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Guidon
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Grisoli
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France.
authors.forename: Vlad
authors.initials: V
authors.lastname: Gariboldi
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France.
authors.forename: Alberto
authors.initials: A
authors.lastname: Riberi
authors.affiliation: Department of Cardiology, La Timone Hospital, 13005 Marseille, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France.
authors.forename: Annick
authors.initials: A
authors.lastname: Mouly-Bandini
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Collart
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D005602:France; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016278:Ventricular Function, Right; D014850:Waiting Lists / Q000401:mortality*
keywords: Dysfonction ventriculaire droite; Heart failure; Heart transplantation; Insuffisance cardiaque terminale; Mortalité sur liste d’attente; Post-transplant survival; Right ventricular function; Survie post-transplantation; Transplantation cardiaque; Waiting-list mortality