Abstract 3999: Risk of Functional Decline in Patients With Symptomatic Cerebrovascular Disease Undergoing Heart Transplantation: An Analysis of the United Network for Organ Sharing (UNOS) Registry
Introduction: Symptomatic cerebrovascular disease (CVD) is considered a relative contraindication to heart transplantation (HT). However, functional status in patients with symptomatic CVD who undergo HT has not been studied.
Methods: We analyzed all first time, single organ HT recipients, 40 yrs or older, in the US from April 1994 to December 2006, entered into the UNOS registry with known symptomatic CVD status noted in the transplant candidate registration form, for the risk of functional decline. A change in functional status from “performs activities of daily living (ADLs) with no assistance” to “performs ADLs with some assistance” or a lower category was considered a functional decline. Also a change in functional status from “80%-normal activity with effort” to “70%- cares for self” or a lower category, without return to prior level of activity during follow-up, was considered a functional decline. Patients with missing functional status information at follow-up or who had poor functional status at time of transplant without improvement during follow up were excluded from the analysis. Risk of post-transplant functional decline was ascertained through Kaplan-Meier survival curves and through Weibull accelerated failure time model. Analysis was adjusted for pre-transplant factors known to affect the post transplant outcomes.
Results: Unadjusted risk of functional decline was higher in symptomatic CVD group than in the no symptomatic CVD group at all time points studied (Table 1⇓). At 10 yrs after transplant 44.3% in the symptomatic CVD group vs. 32.9% in the no symptomatic CVD group had functional decline (p<0.0001). In multivariate analysis, patients with symptomatic CVD were more likely to have functional decline (HR 1.31, 95% CI: 1.10, 1.56).
Conclusions: Pre-transplant symptomatic CVD is associated with increased risk of functional decline following HT. These results should be considered when evaluating a patient with symptomatic CVD for HT candidacy.