[Indications for heart transplant: retrospective evaluation of criteria for selection of candidates].

INTRODUCTION

Heart transplantation (HT) is a largerly accepted therapy for patients with refractory congestive heart failure. However, lack of donors imposes a rigorous choice among candidates for transplantation. Aim of this study was to identify retrospectively determinants for the selection of recipients.

METHODS

Between december 1985 and december 1993 500 patients were listed for HT at the Department of Cardiovascular Surgery of the Padua University. Among United Network for Organ Sharing (UNOS) status II patients, 42 transplanted (group I) and 38 died waiting for a donor (group II) were chosen. The following parameters were collected at the time of insertion into the waiting list: sex, blood group, diagnosis, age, body surface area, natriemia, renal function, hepatic function, presence of ventricular arrhythmias, use of ACE-inhibitors, cardiac index, mean pulmonary pressure, mean wedge pressure, mean arterial pressure, central venous pressure, pulmonary arteriolar resistances, left ventricular ejection fraction. Also the time on waiting list until a final event (transplantation or death) was considered.

RESULTS

Comparing the two groups the diagnosis of dilated cardiomyopathy (59.4% group I vs 36.8% group II; p = 0.04) and ejection fraction (26.4 +/- 9.1% group I vs 22.2 +/- 8.0% group II; p = 0.03) were the only variables statistically different. Multivaried analysis evidenced some parameters as independent predictors for HT. In detail, being listed for HT for more than 6 months lowered the probability to receive a heart to 0.34, while waiting for more than 12 months increased it to 2.64. Mean arterial pressure higher than 75 mmHg increased the probability for HT to 2.87, while an increase in mean pulmonary pressure of 5 mmHg lowered the probability to 0.80. An increase in the cardiac index of 0.5 l/m1/m2 lowered the probability to 0.61. A blood group other than 0 increased the possibility to 3.60, the basal surface area higher than 1.78 m2 lowered it to 0.306 and an ejection fraction higher than 22% increased it to 3.94.

CONCLUSIONS

We can conclude that parameters which predict the outcome of patients listed for HT were not only size matching, blood group and waiting time, but also ejection fraction, arterial pressure and diagnosis.