Effect of receiving a heart transplant: analysis of a national cohort entered on to a waiting list, stratified by heart failure severity  Commentary: Time for a controlled trial?

doi:10.1136/bmj.321.7260.540

BMJ 2000;321:540-545 ( 2 September )

Papers

Effect of receiving a heart transplant: analysis of a national cohort entered on to a waiting list, stratified by heart failure severity

Editorial by Hunt

Mario C Deng, associate professor of medicine and cardiology, ^a Johan M J De Meester, head of medical affairs, ^b Jacqueline M A Smits, biostatistician, ^b Joachim Heinecke, senior biostatistician, ^c Hans H Scheld, professor and director, ^a on behalf of the Comparative Outcome and Clinical Profiles in Transplantation (COCPIT) Study Group.

^a Department of Cardiothoracic Surgery, Muenster University, D-48129 Muenster, Germany, ^b Eurotransplant Foundation, PO Box 2304, 2301 CH Leiden, Netherlands, ^c Institute for Biomathematics, Muenster University, D-48129 Muenster, Germany

Correspondence to: M C Deng, Heart Failure Center, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA md785{at}columbia.edu

Objective: To determine whether there is a survival benefitassociated with cardiac transplantation inGermany.
Design: Prospective observational cohortstudy.
Setting: All 889 adult patients listed for a firstheart transplant in Germany in1997.
Main outcome measure: Mortality, stratified by heart failureseverity.
Results: Within 1 year after listing, patients witha predicted high risk had the highest global death rate (51% v32% and 29% for medium and low risk patients respectively; P<0.0001),had the highest risk of dying on the waiting list (32% v 20% and20%; P=0.0003), and were more likely to receive a transplant (48%v 45% and 41%; P=0.01). Differences between the risk groups inoutcome after transplantation did not reach significance (P=0.2).Transplantation was not associated with a reduction in mortalityrisk for the total cohort, but it did provide a survival benefitfor the high riskgroup.
Conclusion: Cardiac transplantation in Germany is currentlyassociated with a survival benefit only in patients with a predictedhigh risk of dying on the waiting list. Patients with a predictedlow or medium risk have no reduction in mortality risk associatedwith transplantation; they should be managed with organ savingapproaches rather thantransplantation.

© BMJ 2000

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

Relevant Articles

Effect of receiving a heart transplant: D K Satchithananda, S C Stoica, J Parameshwar, S R Large, J Wallwork, L D Sharples, Guy A MacGowan, Srinivas Murali, Robert J MacFadyen, Mario C Deng, Johan M J De Meester, Jacqueline M A Smits, Joachim Heinecke, and Hans H Scheld
BMJ 2001 322: 1179. [Extract] [Full Text]

Let speculation run riot
BMJ 2000 321: 0. [Full Text] [PDF]

Let speculation run riot
BMJ 2000 321: 0. [Full Text] [PDF]

Cardiac transplantation is worth while only for the sickest patients
BMJ 2000 321: 0. [Full Text]

A fair way of donating hearts for transplantation: Sharon Hunt
BMJ 2000 321: 526. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Musci, M., Loforte, A., Potapov, E. V., Krabatsch, T., Weng, Y., Pasic, M., Hetzer, R. (2008). Body Mass Index and Outcome After Ventricular Assist Device Placement. Ann. Thorac. Surg. 86: 1236-1242 [Abstract] [Full text]
Komoda, T., Hetzer, R., Lehmkuhl, H. B. (2008). Destiny of candidates for heart transplantation in the Eurotransplant heart allocation system.. Eur. J. Cardiothorac. Surg. 34: 301-306 [Abstract] [Full text]
Hoercher, K. J., Nowicki, E. R., Blackstone, E. H., Singh, G., Alster, J. M., Gonzalez-Stawinski, G. V., Starling, R. C., Young, J. B., Smedira, N. G. (2008). Prognosis of patients removed from a transplant waiting list for medical improvement: Implications for organ allocation and transplantation for status 2 patients.. J. Thorac. Cardiovasc. Surg. 135: 1159-1166 [Abstract] [Full text]
Lietz, K., Miller, L. W. (2007). Improved Survival of Patients With End-Stage Heart Failure Listed for Heart Transplantation: Analysis of Organ Procurement and Transplantation Network/U.S. United Network of Organ Sharing Data, 1990 to 2005. J Am Coll Cardiol 50: 1282-1290 [Abstract] [Full text]
Clark, A. L., Knosalla, C., Birks, E., Loebe, M., Davos, C. H., Tsang, S., Negassa, A., Yacoub, M., Hetzer, R., Coats, A. J.S., Anker, S. D. (2007). Heart transplantation in heart failure: The prognostic importance of body mass index at time of surgery and subsequent weight changes. Eur J Heart Fail 9: 839-844 [Abstract] [Full text]
Holschermann, H., Stadlbauer, T. H.W., Wagner, A. H., Fingerhuth, H., Muth, H., Rong, S., Guler, F., Tillmanns, H., Hecker, M. (2006). STAT-1 and AP-1 decoy oligonucleotide therapy delays acute rejection and prolongs cardiac allograft survival. Cardiovasc Res 71: 527-536 [Abstract] [Full text]
Mokadam, N. A., Ewald, G. A., Damiano, R. J. Jr, Moazami, N. (2006). Deterioration and mortality among patients with United Network for Organ Sharing status 2 heart disease: Caution must be exercised in diverting organs. J. Thorac. Cardiovasc. Surg. 131: 925-926 [Full text]
Levy, W. C., Mozaffarian, D., Linker, D. T., Sutradhar, S. C., Anker, S. D., Cropp, A. B., Anand, I., Maggioni, A., Burton, P., Sullivan, M. D., Pitt, B., Poole-Wilson, P. A., Mann, D. L., Packer, M. (2006). The Seattle Heart Failure Model: Prediction of Survival in Heart Failure. Circulation 113: 1424-1433 [Abstract] [Full text]
Newcomb, A. E., Esmore, D. S., Rosenfeldt, F. L., Richardson, M., Marasco, S. F. (2004). Heterotopic Heart Transplantation: An Expanding Role in the Twenty-First Century?. Ann. Thorac. Surg. 78: 1345-1350 [Abstract] [Full text]
Burch, M, Aurora, P (2004). Current status of paediatric heart, lung, and heart-lung transplantation. Arch. Dis. Child. 89: 386-389 [Abstract] [Full text]
Butler, J., Khadim, G., Paul, K. M., Davis, S. F., Kronenberg, M. W., Chomsky, D. B., Pierson, R. N. III, Wilson, J. R. (2004). Selection of patients for heart transplantationin the current era of heart failure therapy. J Am Coll Cardiol 43: 787-793 [Abstract] [Full text]
Deng, M. C. (2004). Heart transplantation: the increasing challenges of evidence-based decision-making. J Am Coll Cardiol 43: 803-805 [Full text]
Hirshberg, B., Rother, K. I., Digon, B. J. III, Lee, J., Gaglia, J. L., Hines, K., Read, E. J., Chang, R., Wood, B. J., Harlan, D. M. (2003). Benefits and Risks of Solitary Islet Transplantation for Type 1 Diabetes Using Steroid-Sparing Immunosuppression: The National Institutes of Health experience. Diabetes Care 26: 3288-3295 [Abstract] [Full text]
Gardner, R S, Martin, W, Carter, R, McDonagh, T A (2003). Importance of {beta} blockade in the treatment of advanced heart failure. Heart 89: 1442-1444 [Full text]
Meluzin, J., Cerny, J., Spinarova, L., Toman, J., Groch, L., Stetka, F., Frelich, M., Hude, P., Krejci, J., Rambouskova, L., Panovsky, R. (2003). Prognosis of patients with chronic coronary artery disease and severe left ventricular dysfunction. The importance of myocardial viability. Eur J Heart Fail 5: 85-93 [Abstract] [Full text]
Zipfel, S., Schneider, A., Wild, B., Lowe, B., Junger, J., Haass, M., Sack, F.-U., Bergmann, G., Herzog, W. (2002). Effect of Depressive Symptoms on Survival After Heart Transplantation. Psychosom. Med. 64: 740-747 [Abstract] [Full text]
Zugck, C., Haunstetter, A., Kruger, C., Kell, R., Schellberg, D., Kubler, W., Haass, M. (2002). Impact of beta-blocker treatment on the prognostic value of currently used risk predictors in congestive heart failure. J Am Coll Cardiol 39: 1615-1622 [Abstract] [Full text]
Anyanwu, A C, Rogers, C A, Murday, A J (2002). Intrathoracic organ transplantation in the United Kingdom 1995-99: results from the UK cardiothoracic transplant audit. Heart 87: 449-454 [Abstract] [Full text]
Deng, M.C, Ascheim, D.D, Edwards, N.M, Naka, Y (2002). End-stage heart failure: which options?. Eur Heart J Suppl 4: D122-D130 [Abstract]
Anyanwu, A. C., McGuire, A., Rogers, C. A., Murday, A. J. (2002). An economic evaluation of lung transplantation. J. Thorac. Cardiovasc. Surg. 123: 411-420 [Abstract] [Full text]
Gradaus, R., Kerber, S., Bocker, D., Scheld, H. H., Breithardt, G., Deng, M. C. (2002). Therapeutic options and heart failure survival score predictability in an academic heart failure center: an analysis of 120 consecutive patients during a 1-year period. Eur J Heart Fail 4: 207-214 [Abstract] [Full text]
Deng, M. C (2002). Cardiac transplantation. Heart 87: 177-184 [Full text]
Frazier, O. H., Rose, E. A., Oz, M. C., Dembitsky, W., McCarthy, P., Radovancevic, B., Poirier, V. L., Dasse, K. A. (2001). Multicenter clinical evaluation of the HeartMate vented electric left ventricular assist system in patients awaiting heart transplantation. J. Thorac. Cardiovasc. Surg. 122: 1186-1195 [Abstract] [Full text]
Zugck, C., Kruger, C., Kell, R., Korber, S., Schellberg, D., Kubler, W., Haass, M. (2001). Risk stratification in middle-aged patients with congestive heart failure: prospective comparison of the Heart Failure Survival Score (HFSS) and a simplified two-variable model. Eur J Heart Fail 3: 577-585 [Abstract] [Full text]
Satchithananda, D K, Stoica, S C, Parameshwar, J, Large, S R, Wallwork, J, Sharples, L D, MacGowan, G. A, Murali, S., MacFadyen, R. J, Deng, M. C, De Meester, J. M J, Smits, J. M A, Heinecke, J., Scheld, H. H (2001). Effect of receiving a heart transplant. BMJ 322: 1179a-1179 [Full text]
Deng, M. C., Loebe, M., El-Banayosy, A., Gronda, E., Jansen, P. G. M., Vigano, M., Wieselthaler, G. M., Reichart, B., Vitali, E., Pavie, A., Mesana, T., Loisance, D. Y., Wheeldon, D. R., Portner, P. M. (2001). Mechanical Circulatory Support for Advanced Heart Failure : Effect of Patient Selection on Outcome. Circulation 103: 231-237 [Abstract] [Full text]
(2000). A New Look at the Survival Effect of Heart Transplantation. JWatch General 2000: 4-4 [Full text]
Hunt, S. (2000). A fair way of donating hearts for transplantation. BMJ 321: 526-526 [Full text]

Rapid Responses:

Read all Rapid Responses

Heart Transplantation: T J Locke
bmj.com, 1 Sep 2000 [Full text]
Cardiac transplantation: David Wainwright Evans
bmj.com, 1 Sep 2000 [Full text]
Re: Heart Transplantation: Mario C Deng
bmj.com, 1 Sep 2000 [Full text]
Re: Cardiac transplantation: Mario C Deng
bmj.com, 3 Sep 2000 [Full text]
Comments on heart transplantation: Herbert N�gele
bmj.com, 13 Sep 2000 [Full text]
Criteria used to list patients for heart transplantation: Guy A MacGowan
bmj.com, 2 Oct 2000 [Full text]
Effect of receiving a heart transplant: Linda Sharples
bmj.com, 2 Oct 2000 [Full text]
Effect of receiving a heart transplant: N R Banner
bmj.com, 2 Oct 2000 [Full text]