Paper: Effect of receiving a heart transplant: analysis of a national cohort entered on to a waiting list, stratified by heart failure severity
Commentary: Time for a controlled trial?
Editorial: A fair way of donating hearts for transplantation
Heart transplantation improves survival only in patients with the worst heart failure and therefore at the highest risk of death while on the waiting list, according to a study in this week's BMJ. This questions the current view in the medical community that transplantation improves the chances of survival for all patients who reach an advanced stage of heart failure.
Deng and colleagues identified all 889 adult patients listed for a first heart transplant in Germany in 1997. Patients were grouped according to disease severity - low, medium and high risk of dying on the waiting list - and a heart failure survival score was calculated for each patient. The authors found that only patients in the high-risk group had a temporary survival benefit from transplantation, whereas the medium and low risk groups showed no such benefit.
These findings challenge the current role of transplantation in heart failure management, say the authors. They suggest that transplantation should be limited to the sickest patients and that low or medium risk patients should instead be managed with organ saving treatments.
Sharon Hunt, Professor of Cardiovascular Medicine at Stanford University in California, reiterates these views in an accompanying editorial. She believes that this study will help to drive forward organ allocation schemes that give donor hearts to those most likely to benefit most from them. It may also intensify the pursuit of alternatives to transplantation, she adds.
Contacts:
[Paper] Mario Deng, Associate Professor of Medicine and Cardiology, Heart Failure Center, Columbia University College of Physicians and Surgeons, New York, USA Email: md785@columbia.edu
[Editorial] Sharon Hunt, Professor of Cardiovascular Medicine, Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA