BMJ 2000;321:540-545 ( 2 September )

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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 benefit associated with cardiac transplantation in Germany.
Design: Prospective observational cohort study.
Setting: All 889 adult patients listed for a first heart transplant in Germany in 1997.
Main outcome measure: Mortality, stratified by heart failure severity.
Results: Within 1 year after listing, patients with a predicted high risk had the highest global death rate (51% v 32% 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% and 20%; P=0.0003), and were more likely to receive a transplant (48% v 45% and 41%; P=0.01). Differences between the risk groups in outcome after transplantation did not reach significance (P=0.2). Transplantation was not associated with a reduction in mortality risk for the total cohort, but it did provide a survival benefit for the high risk group.
Conclusion: Cardiac transplantation in Germany is currently associated with a survival benefit only in patients with a predicted high risk of dying on the waiting list. Patients with a predicted low or medium risk have no reduction in mortality risk associated with transplantation; they should be managed with organ saving approaches rather than transplantation.

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