Please inform your transplant coordinator of any travel that will take you outside the four-hour window. Your health information, right at your fingertips. Read the Latest. While you wait for your new heart: Your transplant cardiologist will schedule follow-up appointments based on your personal needs. You will see your heart transplant surgeon every year, or more frequently, based on your personal needs.
You'll have access to ongoing education while awaiting transplant. All wait times vary. Heart Transplant Status Placement on the heart transplant waiting list will be in accordance to specific criteria met for status levels 1 through 6: 1 - 3: Most often hospitalized in ICU to support their heart. Other factors that may affect your wait time are your: Blood type. Height and weight. Geographic area. Donor heart availability is difficult to predict. The VAD: Pumps blood for you when you have a weakened heart muscle.
Allows you to live a healthier, more active life while you wait for transplant. May also lengthen your time on the waitlist. Question What is the current status of survival of patients on the heart transplantation waiting list? Meaning Although not a replacement for heart transplant, continued improvement in heart failure therapy outcomes were associated with a survival benefit while patients awaited heart transplantation, although listing practices remain highly variable among centers; this finding may support a future approach of incorporating this survival benefit into the indications for heart transplantation.
Importance With continuing improvements in medical devices and more than a decade since the United Network for Organ Sharing UNOS allocation policy, it is pertinent to assess survival among patients on the heart transplantation waiting list, especially given the recently approved UNOS allocation policy. Objectives To assess survival outcomes among patients on the heart transplant waiting list during the past 3 decades and to examine the association of ventricular assist devices VADs and the UNOS allocation policy with survival.
Patients were followed up from the time of listing to death, transplantation, or removal from the list due to clinical improvement. Competing-risk, Kaplan-Meier, and multivariable Cox proportional hazards regression analyses were used. Main Outcomes and Measures The analysis involved an unadjusted and adjusted survival analysis in which the primary outcome was death on the waiting list.
Because of changing waiting list preferences and policies during the study period, the intrinsic risk of death for wait-listed candidates was assessed by individually analyzing, comparing, and adjusting for several candidate risk factors. In the setting of changes in listing preferences, 1-year survival on the waiting list increased from The 1-year waiting list survival for candidates with VADs increased from Similarly, in the setting of changing mechanical circulatory support indications, the 1-year waiting list survival for patients without VADs increased from In the decade prior to the UNOS allocation policy, the 1-year waiting list survival was In adjusted analysis, each time period after had a marked decrease in waiting list mortality.
Conclusions and Relevance This study found temporally associated increases in heart transplant waiting list survival for all patient groups with or without VADs, UNOS status 1 and status 2 candidates, and candidates with poor functional status.
The 50th anniversary of heart transplantation was recognized in It is widely held that heart transplantation offers a significant survival benefit. There is a growing body of evidence suggesting that patients on the waiting list for heart transplantation are surviving much longer with ventricular assist devices VADs. It was our aim to reassess the outcomes among patients on the waiting list in the present day. We hypothesize that improvements in both the medical management of heart failure and the mechanical devices used were associated with improved waiting list survival during the last 3 decades.
We sought to individually analyze and then concurrently compare the overall survival outcomes, during a 5-year period from the time of wait-listing, of candidates on the heart transplant waiting list and candidates who received a transplant. Our analysis also used the heart registry, with data collected by the Organ Procurement and Transplantation Network.
The characteristics of the recipients were reported at the time of transplant. Follow-up information was collected 6 months after transplantation and yearly thereafter. Baylor College of Medicine determined that no separate institutional review board approval was necessary for this study because the data were already deidentified when obtained.
We arbitrarily stratified the data to create the following time period cohorts: the , , , , , and eras. The candidate risk factors and clinical characteristics used in this analysis, with their percentage of entry completion, are listed in Table 1.
The covariates included in our analysis are based on the current literature and consistent data completion. To account for various listing criteria across different regions and to account for changing listing preferences and policies during the study period, we attempted to depict the intrinsic risk of death for candidates on the waiting list and study it across the different eras.
In the UNOS database, for the , , , and eras, functional status 1 was reported for candidates who performed activities of daily living with no assistance, functional status 2 for candidates requiring some assistance, and functional status 3 for candidates requiring total assistance.
We also grouped status 1 candidates as defined by UNOS before and status 1A and status 1B candidates as defined currently by UNOS as status 1 for the multivariable regression analysis. Despite variabilities in data entry from patient registries, most of the risk factors in our analysis had a very high percentage of entry completion. In our adjusted model analyzing the different eras, the era was the reference era. We also conducted a second adjusted analysis in which we did not include the era, owing to a lack of data about use of VADs and ECMO prior to The primary outcome variable was death on the waiting list.
In our waiting list analysis, this outcome was established by the death date in the UNOS database accounting for publicly reported external sources. For candidates who were delisted for transplantation and lost to the database, we established the date of death by the Social Security Death Master File. However, Social Security Death Master File data were not available after February ; to account for candidates who were missing a UNOS database death date and were delisted after this date, we performed a parallel analysis in which waiting list removal for deteriorating clinical condition was counted as death on the waiting list.
As the rate of transplantation was significantly higher than the rate of dying while on the waiting list, we performed 2 competing risk regression analyses, one based on the method of Fine and Gray 9 and the other using the Cox cause-specific proportional hazards regression analysis.
Competing risk refers to the probability that 1 event—a competing event—can prevent the event of interest from occurring if it occurs first; in our case, removal from the waiting list by either receipt of a transplant or recovery will mean that individual must be mathematically considered no longer at risk of death, either by censoring Cox proportional hazards regression or by assigning a zero risk of death Fine and Gray analysis.
Given that the change in the intrinsic risk of death of wait-listed candidates could have been the primary factor associated with the improving outcomes, we stratified our study population into groups based on the risk factors previously identified and performed a competing risk regression analysis for each group. We sought to individually analyze and then concurrently compare the subhazard ratio SHR and cause-specific hazard CSH for the era of listing among each stratum; all SHRs and CSHs for each subgroup of patients are presented in eTable 4 in the Supplement.
In our waiting list survival analysis, the primary outcome measure was death on the waiting list. Patients who underwent transplantation or were removed from the waiting list owing to clinical improvement were censored at the time of removal from the waiting list.
All patients were followed up from the time of listing to death on the waiting list, transplantation, or removal from the list due to clinical improvement. In our posttransplant survival analysis, candidates were followed up from the time of listing to death after transplantation or to the last known follow-up. Patients who were lost to follow-up or alive on December 29, , were censored at the date of last known follow-up, and only patients who received a transplant were included in the posttransplant survival analysis.
Because 5-year outcomes for the era were truncated, possibly underestimating the 5-year mortality for this era, we also reported 1-year and 3-year survival outcomes to better allow for a comparison between eras. Data were analyzed using the Stata, version 15 statistical software package Stata Corp.
Continuous variables were summarized using mean SD values and compared using the t test. Percentages between various eras were compared using a 2-sample test for proportions, and the differences in proportions between eras have been reported. Demographic and clinical characteristics are summarized in Table 1. The UNOS reports sex as male or female; we arbitrarily reported the percentage of men by era in Table 1 for brevity.
Candidate age and body mass index increased across all eras compared with the era. Similarly, the percentages of patients with diabetes, undergoing dialysis, receiving inotropes, with an IABP, and needing ventilators all increased over time compared with the reference era Table 1. Candidates on the waiting list who were receiving ECMO significantly increased from 1. Similarly, candidates on the waiting list with VADs significantly increased from There was an increase in the percentage of patients in each functional status group across the study period.
Because of the lack of available hearts, it's rarely possible to have a heart transplant as soon as it's needed, so you'll usually be placed on a waiting list. It may be several months, or possibly years, before a donor heart of the right size and blood group becomes available. Many people are well enough to stay at home until a heart becomes available, although some people will need to remain in hospital. The transplant centre can offer support, guidance and information while you wait for a suitable donor to be found.
While waiting for a donated heart to become available, it's important to stay as healthy as possible by:. The transplant centre will need to be able to contact you at short notice, so you should inform staff if your contact details change.
You should also let staff know if your health changes — for example, if you develop an infection. Prepare an overnight bag and make arrangements with your friends, family and employer so you can go to the transplant centre as soon as a donor heart becomes available.
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