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?

Abstract

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.

2013 ACCF/AHA Guideline for the Management of Heart Failure

“…[682][683][684][685][686][687][688] The greatest survival benefit is seen in those patients who are at highest risk of death from advanced HF. 689 Cardiopulmonary exercise testing helps refine candidate selection. [690][691][692][693][694][695][696] Data suggest acceptable posttransplant outcomes in patients with reversible pulmonary hypertension, 697 hypertrophic cardiomyopathy, 698 peripartum cardiomyopathy, 699 restrictive cardiomyopathy, 700,701 and muscular dystrophy.…”

A Peripheral Blood Transcriptome Biomarker Test to Diagnose Functional Recovery Potential in Advanced Heart Failure

“…Risk stratification and subsequent outcome prediction as well as therapeutic recommendation-making needs to be based on the comparative survival benefit rationale [48,49]. Several clinical parameters have been associated with increased mortality in HF.…”

Current indications for transplantation: stratification of severe heart failure and shared decision-making

“…Risk stratification and subsequent outcome prediction, as well as therapeutic recommendation-making needs to be based on the comparative survival benefit rationale (33). Determining which patients with stage D HF would derive the most benefit from advanced therapies and recognizing the appropriate timing for administering these therapies before development of profound multi-OD, remains one of the most important aspects of care in this patient population.…”