Predictors of failure after high urgent listing for a heart transplant

Abstract

OBJECTIVES: As waiting times for a heart transplant (HTx) increase, the decision of whether a patient should have a high urgent (HU) listing or mechanical circulatory support becomes crucial for further prognosis. The aim of this study was to determine the characteristics that predict failure of an HU listing (death/delisting due to urgent mechanical circulatory support implant or poor clinical condition), the 5-year survival rate, the 1-year post-transplant survival rate and the prognostic accuracy of the cardiac allocation score of patients on the HU list. METHODS: A total of 447 patients who were on the HU list at our institution between 2005 and 2016 were analysed and stratified according to occurrence of therapy failure or reception of an HTx. RESULTS: A total of 114 patients suffered from HU listing failure after a median HU time of 31.5 (15–69) days; 320 patients had a primary HTx after a median time of 51.5 (26–90) days on the HU list; 13 patients were excluded from data analysis because of an ongoing HU listing or delisting due to improvement in their haemodynamic condition. In multivariable logistic regression analysis, blood group 0 [odds ratio (OR) 2.48, 95% confidence interval (CI) 1.43–4.3; P = 0.001], INTERMACS Class 1 or 2 (OR 5.1, 95% CI 2.7–9.4; P < 0.001), vasoactive inotropic score (OR 1.18, 95% CI 1.09–1.27; P < 0.001) and brain natriuretic peptide levels (OR 1.00, 95% CI 1.00–1.00; P = 0.001) were identified as independent predictors of HU listing failure. Cardiac allocation score was not independently associated with listing failure. Estimated 5-year and 1-year post-HTx survival rates were similar in the primary HTx group and in patients receiving an HTx after HU therapy failure (P = 0.48 and P = 0.7, respectively). CONCLUSIONS: INTERMACS levels 1 and 2 and vasoactive inotropic score were the strongest predictors of HU listing failure.