The effect of heart transplantation on mortality in end-stage heart failure patients with UNOS status 2 [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2006; 34(8): 479-483

The effect of heart transplantation on mortality in end-stage heart failure patients with UNOS status 2

Hamza Duygu1, Mehdi Zoghi1, Sanem Nalbantgil1, Çağatay Engin2, Tahir Yağdı2, Azem Akıllı1, Mustafa Akın1, Mustafa Özbaran2
1Department of Cardiology, Ege University, İzmir, Turkey
2Department of Cardiac Surgery, Ege University, İzmir, Turkey


OBJECTIVES
Despite recent developments in medical treatments and assist device applications, management strategies for end-stage heart failure patients with UNOS status 2 (United Network for Organ Sharing) are still controversial. We evaluated the clinical condition and prognosis of end-stage heart failure patients with UNOS status 2, who were placed on the waiting list for heart transplantation.

STUDY DESIGN
The study included 78 patients (62 men, 16 women; mean age 43±12 years) with UNOS status 2. The patients were assessed in terms of frequency of hospitalization during waiting for transplantation, shift to a higher level of UNOS status, transplantations performed, and mortality.

RESULTS
The mean duration of waiting on the list was 17±10 months. The frequency of hospitalization due to heart failure was 4±2/year. An implantable cardioverter defibrillator was used in seven patients (9%) for persistent ventricular tachycardia. Nine patients (11.5%) shifted to UNOS status 1B. Eighteen patients (23.1%) underwent orthotopic heart transplantation following six months of waiting on the list. Mortality rates were 25% (n=15) and 22.2% (n=4) for patients on the waiting list and for transplant patients at the end of the first year of transplantation, respectively (p=0.03). The main cause of mortality was sudden cardiac death (73.3%, n=11) for patients on the transplantation list. There was a significant difference in terms of combined end-point of mortality and shift to UNOS status 1B between transplanted (n=24, 40%) and untransplanted (n=4, 22.2%) patients (p=0.01).

CONCLUSION
Heart transplantation is an appropriate alternative for preventing impending clinical deterioration, frequent attacks of heart failure, and cardiac deaths in patients with UNOS status 2.

Keywords: Death, sudden/etiology, heart failure, congestive, heart transplantation; patient selection; waiting lists

How to cite this article
Hamza Duygu, Mehdi Zoghi, Sanem Nalbantgil, Çağatay Engin, Tahir Yağdı, Azem Akıllı, Mustafa Akın, Mustafa Özbaran. The effect of heart transplantation on mortality in end-stage heart failure patients with UNOS status 2. Turk Kardiyol Dern Ars. 2006; 34(8): 479-483

Corresponding Author: Hamza Duygu, Türkiye
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