Prognosis of patients removed from a transplant waiting list for medical improvement: Implications for organ allocation and transplantation for status.

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Presentation transcript:

Prognosis of patients removed from a transplant waiting list for medical improvement: Implications for organ allocation and transplantation for status 2 patients Katherine J. Hoercher, RN, Edward R. Nowicki, MD, MS, Eugene H. Blackstone, MD, Gurmeet Singh, MD, Joan M. Alster, MS, Gonzalo V. Gonzalez-Stawinski, MD, Randall C. Starling, MD, MPH, James B. Young, MD, Nicholas G. Smedira, MD The Journal of Thoracic and Cardiovascular Surgery Volume 135, Issue 5, Pages 1159-1166 (May 2008) DOI: 10.1016/j.jtcvs.2008.01.017 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Freedom from return of heart failure (HF; return to New York Heart Association Class IV, relisting for transplantation, implementation of mechanical circulatory support, or death from heart failure). Each symbol represents a death positioned actuarially, vertical bars are 68% confidence limits, and numbers in parentheses are patients remaining at risk. The solid line is the parametric estimate enclosed within dashed 68% confidence limits. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1159-1166DOI: (10.1016/j.jtcvs.2008.01.017) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Risk of sudden death after delisting among patients without an implantable cardioverter−defibrillator. Dashed lines represent 68% confidence limits. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1159-1166DOI: (10.1016/j.jtcvs.2008.01.017) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Competing risks after delisting for medical improvement. A, Rates of transition from event-free survival to heart failure, sudden cardiac death, or death from other causes. B, Resulting proportion of patients in each state (event-free survival, heart failure, sudden cardiac death, or other modes of death) across follow-up. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1159-1166DOI: (10.1016/j.jtcvs.2008.01.017) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Simulated improvement in event-free survival of patients were sudden cardiac death to be eliminated by inserting implantable cardioverter−defibrillators (ICD). Parametric survival curves are formatted as for Figure 1, except parametric confidence limits are not shown. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1159-1166DOI: (10.1016/j.jtcvs.2008.01.017) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Survival of medically improved patients after delisting. Format is as in Figure 1. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1159-1166DOI: (10.1016/j.jtcvs.2008.01.017) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Comparison of survival of medically improved patients after delisting (circles) to propensity-matched Unified Network for Organ Sharing status 2 patients after cardiac transplantation (squares). Format is as in Figure 1. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1159-1166DOI: (10.1016/j.jtcvs.2008.01.017) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions