Considerations for Patients Awaiting Heart Transplantation

Abstract

The aim of this study is to provide a description of patients on the waiting list for heart transplants in Germany; the focus is on comparing the era after implementation of the new transplant law with the former era. This study used data from the Eurotransplant registry. The population consisted of all patients who registered for heart transplantation in Germany between January 1990 and May 2009. Patients were followed up to the earliest of the following events: heart transplantation, death, or end of the observation period. The actual mortality rates were calculated using a competing risk methodology. The proportion of patients on the waiting list aged 65 years or older has increased from 1.9 % in 1990 to 8.3 % in 1997, 7.8 % in 2000 and 12.6 % on December 31, 2008. The 1-year waiting list mortality rate, expressed as the proportion of patients who die within 1 year after being listed for heart transplantation decreased in the period 2001-2009 compared to the period 1991-2000. Patients registered in the period from 1991-2000 had a 25.9 % chance of dying prior to heart transplantation compared to 18.9 % for patients who were registered in the years 2001-2009. In the registration period 1981-1990, a transplant candidate had a 64.3 % chance of undergoing heart transplantation within the first year after being listed, while for patients who were registered in the period 2001-2009 this probability has been reduced to 40.2 %. Despite the fact that patient profiles have worsened and access to transplantation decreased, mortality rates of patients on the heart transplant waiting list have decreased. These data show that treatment of patients with advanced heart disease has improved in Germany.

Impact of the Eurotransplant High-Urgency Heart Allocation System on the Outcome of Transplant Candidates in Germany

“…Smits et al demonstrated that the accrued waiting time on the waiting list for HTx has risen dramatically. While in 1990, 84.6 % of all patients had a waiting time shorter than 1 year, this proportion had decreased to 68.8 % in 1997 and had dropped to 37.8 % in 2008 [10]. In addition, Smits reported that a roughly constant number of new registrations for patients requiring HTx in Germany since 2003 faces a decreasing number of HTx performed over the last 10 years (1997: 526 HTx; 2000: 402 HTx; 2008: 346 HTx) [10].…”

“…While in 1990, 84.6 % of all patients had a waiting time shorter than 1 year, this proportion had decreased to 68.8 % in 1997 and had dropped to 37.8 % in 2008 [10]. In addition, Smits reported that a roughly constant number of new registrations for patients requiring HTx in Germany since 2003 faces a decreasing number of HTx performed over the last 10 years (1997: 526 HTx; 2000: 402 HTx; 2008: 346 HTx) [10]. This is presumably aggravated by the dramatic shortage of donor organs in Germany, where the number of multiorgan donors per million of the population is very low: 15.9 in Germany compared with 34.3 in Spain, 28.2 in Belgium, and 25.3 in France.…”

“…In our retrospective analysis, we could demonstrate a significant decrease in the ratio of elective HTx procedures as well as a significant increase in the ratio of urgent HTx after the enactment of the GTL. Comparing the era before and after implementation of the new transplantation law, Smits et al found in a retrospective analysis of all patients undergoing HTx in Germany between 1997 and 2009 that the proportion of patients listed as having an urgency status while undergoing HTx has dramatically increased from 0.4% in 1997 to 72.7% in 2008 [10]. Smits et al demonstrated that the accrued waiting time on the waiting list for HTx has risen dramatically.…”

Asistencia ventricular intracorpórea en falla cardiaca terminal

“…Sin embargo, existe un grupo de enfermos refractarios que avanzan irremediablemente a insuficiencia cardiaca terminal (ICT), cuya única alternativa terapéutica es el trasplante cardiaco 3,4 . Desafortunadamente, es una opción limitada por el escaso número de donantes y muchos mueren esperando un órgano 5 . Recientemente, la asisten-cia ventricular (AV) extra o intracorpórea emerge como una alternativa terapéutica viable para pacientes con ICT, permitiendo su sobrevida hasta ser trasplantados 6 .…”

Transfection of Short-Interfering RNA Silences Adhesion Molecule Expression on Cardiac Microvascular Cells

“…Heart transplantation remains one of the gold standards for the treatment of end-stage heart failure, irrespective of whether heart failure has resulted from coronary artery disease, congenital heart defects or progressive cardiomyopathy. However, peopleʼs willingness to donate organs is still low [1,2] and reducing graft rejection rates is therefore of the utmost importance. Besides immunologically modulated graft rejection, vascular graft failure represents the most frequent late cause of death after heart transplantation [3].…”