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(Circulation. 2000;102:e9024.)
© 2000 American Heart Association, Inc.

Cardiovascular News

Cardiovascular News

Dana St. John Kolar, Circulation Managing Editor, Special Projects

Heart Transplant Survival Rate Best in High-Risk Group

A recent study of patients on the transplant waiting list in Germany, the Comparative Outcomes and Clinical Profiles In Transplantation (COCPIT) study by Mario Deng and colleagues, reports that heart transplants improve survival only in patients at greatest risk of dying. Those with a low or medium risk had no reduction in mortality through transplantation. The results appeared in the September 2, 2000 issue of the British Medical Journal (BMJ 2000;321:540–545).

The authors analyzed the survival benefit from heart transplantation in 889 patients listed for heart transplantation at all centers in Germany for a 1-year period in 1997. The patients were assigned according to the Heart Failure Survival Score to groups labeled as low, medium, and high risk of death from heart failure.

The patients at high risk had the highest global death rate (51%), compared with 32% for the medium-risk patients and 29% for the low-risk patients. There was no reduction in mortality risk associated with transplantation in the patients with a predicted low or medium risk. Deng and his colleagues recommend managing the medium- and low-risk patients with organ-saving approaches rather than transplantation.

In a related commentary, Dr. Tom Treasure and Dr. Andrew Murday speculate about whether the patients on the waiting list who have not received a transplant are the best comparison group to use, and suggest a clinical trial to explore the issue. They suggest, "It may be as ethical to allocate the limited supply of hearts within carefully designed clinical trials as by the clinical . . . [Full Text of this Article]