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Who needs ‘bridge’ to transplantation in the presence of the Eurotransplant high-urgency heart transplantation program?

^a Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany
^b Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany

Received 18 February 2008; received in revised form 25 May 2008; accepted 27 May 2008.

^_* Corresponding author. Tel.: +49 6211 56 6278; fax: +49 6221 56 5585. (Email: hiroyuki.kamiya{at}med.uni-heidelberg.de).

Introduction: The purposes of this study are to identify a patient cohort that would benefit from the use of mechanical circulatory support (MCS) in the presence of the Eurotransplant high-urgency (HU) program. Methods: Sixty-five patients (heart transplantation (HTx) group, 77%) underwent heart transplantation and 17 patients (D group, 20%) died while on the HU waiting list. These 82 patients were included in this retrospective study. Results: The mean waiting time on HU list was 18.3 ± 17.7 days in HTx group and 12.5 ± 9.4 days in D group (p = 0.075). The average weekly allocation rate from the active HU list was 27.7%, and the mean weekly waiting-list mortality was 12.1%. The use of intra-aortic balloon pumping (p = 0.005), mechanical ventilation (p = 0.007), higher dose of dobutamine (0.005), lower serum level of sodium (p = 0.046), and higher serum level of C reactive protein (CRP) (0.040) at the registration of HU listing were associated with waiting-time mortality, and the serum creatinine level more than 1.5 mg/dl (p = 0.007, odds ratio; 14.5, 95% CI; 2.1–102.0) and the serum CRP level more than 10 mg/l (p = 0.026, odds ratio; 6.3, 95%CI; 1.2–31.4) were identified as significant predictors. Conclusion: It would be appropriate that a patient who would not be able to tolerate one or two weeks waiting time to be considered as a candidate for MCS implantation in the presence of the HU program. The patient selection criteria for MCS implantation should include not only hemodynamic parameters, but also the aspect of a beginning multi-organ failure.

Key Words: Heart transplantation • Eurotransplant • Mechanical circulatory support

This article has been cited by other articles:

				J. R. Sindermann, C. Vahlhaus, A. Hoffmeier, H. H. Scheld, and S. Klotz Impact of ventricular assist device support on post-transplant mortality searching for reasons. J. Am. Coll. Cardiol., August 4, 2009; 54(6): 573 - 573. [Full Text] [PDF]

				M. Strueber Editorial comment: Indication for mechanical circulatory support in high urgent heart transplant candidates Eur. J. Cardiothorac. Surg., December 1, 2008; 34(6): 1134 - 1135. [Full Text] [PDF]