August 13, 2020
2 min read
Bakhtiyar reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Survival on heart transplant waiting lists increased over time in patients with or without ventricular assist devices, poor functional status and United Network for Organ Sharing status 1 and status 2 candidates, researchers found.
“Our data suggest that survival on the waiting list is increasing faster than survival after transplantation,” Syed Shahyan Bakhtiyar, MBBS, researcher in the department of surgery at Baylor College of Medicine when conducting the study and is now a general surgery resident at Johns Hopkins Hospital, and colleagues wrote in the study published in JAMA Cardiology. “Continued improvement in outcomes for heart failure therapy among patients on the waiting list may support continued attention to balancing the survival benefit of existing supportive therapies against the indication for heart transplantation.”
In this retrospective cross-sectional study, researchers analyzed data from 95,323 patients (mean age, 52 years; 76.5% men) from the United Network for Organ Sharing database who were wait-listed for heart transplantation from 1987 to 2017. Patients were followed up from the time of wait-listing to transplantation, death or removal from the list for clinical improvement. The primary outcome variable for this study was death on the waiting list.
Survival at 1 year for patients still on the waiting list increased from 34.1% in 1987-1990 to 67.8% in 2011-2017 (difference in proportions, 0.34%; 95% CI, 0.32-0.36; P < .001).
One-year survival on the waiting list for patients with ventricular assist devices increased from 10.2% in 1996-2000 to 70% in 2011-2017 (difference in proportions, 0.6%; 95% CI, 0.58-0.62; P < .001). Increases during these periods were similar for patients without ventricular assist devices (53.9% to 66.5%; difference in proportions, 0.13%; 95% CI, 0.12-0.14; P < .001).
Waiting list survival in the decade before the 2006 United Network for Organ Sharing allocation policy was 51.1%, which increased to 63.9% the decade after it was implemented (difference in proportions, 0.13%; 95% CI, 0.12-0.14; P < .001).
Adjusted analyses determined that marked decreases in waiting list mortality occurred in each period after 1987-1990.
“The reasons behind these observed improvements are likely multifactorial, including variations in listing preferences, overall better medical management, improved mechanical devices, and the greater use of mechanical devices and implantable cardioverter defibrillators prior to transplantation,” Bakhtiyar and colleagues wrote. “Although there are numerous reasons for survival on the waiting list to be genuinely improving, some component of changed and optimized listing behaviors is likely also a factor.”