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Influence of New Eurotransplant Heart Allocation Policy on Outcome of Heart Transplant Candidates in Germany

Journal
The Journal of Heart and Lung Transplantation
Publisher
Elsevier
Publication Date
Jan 01, 2008
Volume
27
Issue
10
Identifiers
DOI: 10.1016/j.healun.2008.07.011
Disciplines
  • Computer Science
  • Medicine
License
Unknown

Abstract

Background The Eurotransplant community adopted an urgency-based heart allocation algorithm in August 2000. The effect of the new allocation policy on critically ill patients with end-stage heart failure was studied. Methods During 1997–1999 (old algorithm) and 2001–2006 (new algorithm), 661 heart transplant candidates received heart transplantation (HTx) or a ventricular assist device (VAD) at our center. Those patients who received VAD or urgent HTx (decompensated) were assigned to Group D-97 ( n = 108) and Group D-01 ( n = 307) under the old and new algorithm, respectively, and regarded as critically ill. We defined subgroups of critically ill patients as follows: Group VAD-97 ( n = 92) and Group VAD-01 ( n = 184), who underwent primary VAD implantation under the old and new allocation algorithm, respectively; and Group UTx-97 ( n = 16) and Group UTx-01 ( n = 123), who underwent urgent HTx under the old and new algorithm. Group survival rates were studied. Results Group D-01 had significantly higher survival rates than D-97 (61.7% vs 44.4%, 2-year survival; p < 0.001). The ratio of patients with urgent HTx (Group UTx-01) among the patients in Group D-01 was significantly greater than that in Group D-97 (40.1% vs 14.8%, p < 0.001). Survival rates of Group UTx-01 after urgency listing (71.5% for 2-year survival) were significantly better than those after VAD implantation in Groups VAD-01 and VAD-97. Conclusions The new heart allocation algorithm has successfully improved survival rates of critically ill patients, enabling these patients to receive urgent HTx.

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