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Heart transplants benefit only the sickest patients

September 01, 2000

Heart transplantation improves survival only in patients with the worst heart
failure and therefore at the highest risk of death while on the waiting list,
according to a study in this week?s BMJ. This questions the current view in the
medical community that transplantation improves the chances of survival for all
patients who reach an advanced stage of heart failure.

Deng and colleagues identified all 889 adult patients listed for a first heart
transplant in Germany in 1997. Patients were grouped according to disease
severity ? low, medium and high risk of dying on the waiting list ? and a heart
failure survival score was calculated for each patient. The authors found that
only patients in the high-risk group had a temporary survival benefit from
transplantation, whereas the medium and low risk groups showed no such benefit.

These findings challenge the current role of transplantation in heart failure
management, say the authors. They suggest that transplantation should be limited
to the sickest patients and that low or medium risk patients should instead be
managed with organ saving treatments.

Sharon Hunt, Professor of Cardiovascular Medicine at Stanford University in
California, reiterates these views in an accompanying editorial. She believes
that this study will help to drive forward organ allocation schemes that give
donor hearts to those most likely to benefit most from them. It may also
intensify the pursuit of alternatives to transplantation, she adds.

Ludwig-Maximilians-Universitaet Muenchen (LMU)

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