Cardiac transplantation is worth while only for the sickest patients

Cardiac transplantation is considered the optimal treatment for end stage heart failure, but no clear survival benefit has been shown. On page 540 Deng et al describe their study on all patients listed for cardiac transplantation in Germany in 1997, in which they analysed outcomes stratified by severity of heart failure. Only the high risk group had a temporary survival benefit from transplantation, whereas the medium risk and low risk groups showed no benefit. These findings question the role of cardiac transplantation in contemporary heart failure management and may support the initiative for a randomised trial.

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Relevant Article

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?

Mario C Deng, Johan M J De Meester, Jacqueline M A Smits, Joachim Heinecke, Hans H Scheld, Tom Treasure, and Andrew Murday
BMJ 2000 321: 540-545. [Abstract] [Full Text] [PDF]