High-urgency waiting list for cardiac recipients in France: Single-centre 8-year experience

Abstract

OBJECTIVES: The 'Special Urgency1' (SU1) offers a 48-h national priority for critically ill cardiac recipients in France. We evaluated our experience of high-urgency cardiac transplantation. METHODS: Between January 2005 and December 2012, 265 patients met the criteria for SU1 waiting list enrolment at our Institution: 212 patients were transplanted during the SU1 priority period, whereas 53 patients missed SU1 priority donor allocation and were downgraded to the standard waiting list. We compared baseline characteristics and outcomes of SU1 priority patients (SU1 group) with 297 recipients, who underwent transplantation according to standard donor allocation (SL group). A propensity score analysis was performed. RESULTS: Overall occurrence of severe primary graft failure, 1- and 5-year survivals in groups SU1 and SL were 27% vs 26% (P = 0.72), 75% vs 71% (P = 0.36) and 69% vs 59% (P = 0.16). A subgroup analysis was carried out on SU1 patients only: independent risk factors for 1-year mortality were recipient insulin-dependent diabetes (OR 3.83, P = 0.04), recipient history of vascular disease (OR 7.67, P = 0.02), recipient creatinine (OR 1.01, P < 0.01) and unfavourable sex mismatch (male recipient/female donor, OR 2.62, P < 0.01). Period analysis of SU1 patients showed a reduction trend in 1-year mortality over time: 29% (Era I, 2005-08) vs 22% (Era II, 2009-12), P = 0.23. One- and 5-year survivals of patients who missed SU1 donor allocation were 36% and 29%. CONCLUSIONS: Special Urgency1 waiting list allows allocating cardiac donors for critically ill patients without increasing early and midterm mortality. Careful selection of recipients is mandatory in order to improve outcomes.