Abstract 20634: Extended Selection Criterias for Heart Transplant Candidates, a Single Center 10 Years Experience.
Background: The past 30 years of cardiac transplantation (CT) have lead to better medical management of recipients . Many of the original contraindications such as age, diabetes, weight and renal failure are now considered to be relative. We sought to evaluate the impact of these relative contraindication on mortality and hospitalization rate after CT.
Method: From January 2000 to January 2010, we followed 142 transplanted patients for a total 254 person/year follow up time. Primary outcome was a composite of death from any cause and hospitalization for a CT related cause (heart failure, arrhythmia, graft rejection or infection). All prognostic factors of interest were the presence of insulin treated diabetes, age > 65, BMI > 30, transpulmonary gradients > 15 and creatinine clearance < 30 ml/min. Survival analysis was performed using Kaplan Meier cumulative Hazard function and multivariate analysis with Cox-Proportional Hazard models.
Results: Of the 142 patients 49 had one of the considered factors at the time of listing, 38 had 2 and 10 had 3 or more. During follow-up there were 16 deaths in the group with risk factors and 7 in the group without risk factors. Primary outcome occurred in 84 patients (61 hospitalizations and 23 deaths) Mean survival time was 657 days (+/− 879). Patients presenting 2 or more of the considered factors at listing time showed significantly higher rate of the primary outcome during the follow up HR 1.47 , 1.02 – 2.28). These findings were amplified when the patients had 3 or more factors at listing time (HR 2.52, 1.2 – 5.29). Prognostic factor evaluated (Hazard Ratio, 95% CI) showed a non significant increase in the risk of developing the composite outcome. Age (1.43 , 0.9 – 2.7) , low creatinine clearance ( 1.14 ,0.74 – 1.8), high BMI ( 1.53, 0.93 – 2.5), diabetes (1.4 , 0.8 – 2.4), high transpulmonary gradient (1.4, 0.8 – 2.37)
Conclusion: Our data suggest that the presence of multiple co morbidities at baseline in CT candidates might be associated with worse clnical outcomes. This association seems to increase with the number of factors present at listing time. In our quest to increase longevity and quality of life of our CT patients and considering scarcity of organ donors, these findings should be taken into account during the CT candidacy evaluation
- © 2010 by American Heart Association, Inc.