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Right arrow Transplantation - heart

Ann Thorac Surg 2005;80:224-228
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

Alternate Waiting List Strategies for Heart Transplantation Maximize Donor Organ Utilization

Jonathan M. Chen, MDa,*, Mark J. Russo, MD, MSa, Kim M. Hammond, RNa, Donna M. Mancini, MDb, Aftab R. Kherani, MDa, Jen M. Fal, BAa, Pamela A. Mazzeo, BAa, Sean P. Pinney, MDc, Niloo M. Edwards, MDd, Yoshifumi Naka, MD, PhDa

a Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York
b Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
c Division of Cardiology, Mount Sinai School of Medicine, New York, New York
d Department of Cardiothoracic Surgery, University of Wisconsin, Madison, Wisconsin

Accepted for publication January 4, 2005.

* Address reprint requests to Dr Chen, Division of Cardiothoracic Surgery, Pediatric Cardiac Surgery, 3959 Broadway, Suite 2-273, New York, NY10032 (Email: jmc23{at}columbia.edu).

BACKGROUND: Alternate waiting list strategies have been promoted as a means to offer the benefit of heart transplantation to a greater number of candidates. We undertook the current study to evaluate our experience with transplantation in alternate list (AL) candidates.

METHODS: Adults undergoing heart transplantation from January 1, 2001, through April 15, 2004, were evaluated. Selected patients who did not meet criteria for standard listing for heart transplantation were offered alternate listing. Primary posttransplant outcomes included 30-day, 90-day, and more than 90-day mortality, and determinants of perioperative morbidity.

RESULTS: Thirty-seven patients (14.3%) met alternate list criteria. Among these alternate list patients, contraindications to standard listing included age greater than 65 years, amyloidosis, severe diabetes mellitus and peripheral vascular disease, human immunodeficiency virus, and high-risk retransplant. The average age of alternate list donors was 41.2 ± 13.9 years. Survival analysis revealed no posttransplant survival advantage for standard list recipients However, mean ventilatory support time was significantly (p < 0.001) longer in the alternate list group (5.7 ± 9.3 days) compared with the standard group (2.3 ± 4.2 days), and significantly more sternal wound infections (p = 0.03) were observed in the alternate list group (6 [16.2%]) compared with the standard group (13 [5.9%]).

CONCLUSIONS: The alternate list patients demonstrated comparable survival with standard list patients, but did exhibit more ventilatory dependence and sternal wound infections. More than half of alternate list donor organs in the future could be considered for standard list candidates as well. Use of the alternate list reinforces the assertion that, even today, our donor criteria remain too stringent.




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