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?

Abstract

Objective: To determine whether there is a survival benefit associated with cardiac transplantation in Germany. Design: Prospective observational cohort study. Setting: All 889 adult patients listed for a first heart transplant in Germany in 1997. Main outcome measure: Mortality, stratified by heart failure severity. Results: Within 1 year after listing, patients with a predicted high risk had the highest global death rate (51% v 32% and 29% for medium and low risk patients respectively; Pv 20% and 20%; P=0.0003), and were more likely to receive a transplant (48% v 45% and 41%; P=0.01). Differences between the risk groups in outcome after transplantation did not reach significance (P=0.2). Transplantation was not associated with a reduction in mortality risk for the total cohort, but it did provide a survival benefit for the high risk group. Conclusion: Cardiac transplantation in Germany is currently associated with a survival benefit only in patients with a predicted high risk of dying on the waiting list. Patients with a predicted low or medium risk have no reduction in mortality risk associated with transplantation; they should be managed with organ saving approaches rather than transplantation.