Risk Analysis of Waiting-List Mortality in Heart Transplantation: A Multicenter Study in Korea.

PURPOSE: There are few national studies of waiting-list mortality for heart transplantation (HT) in Korea. Our multicenter study examined mortality on the HT waiting list and its associated risk factors.

MATERIALS AND

METHODS

We retrospectively analyzed 1101 consecutive patients who were wait-listed for HT between 2012 and 2017 in four centers. Time on the HT waiting list was defined as the time from initial wait-listing to delisting due to HT, death, or recovery. Subjects were censored at the time of transplantation or recovery.

RESULTS

Of the whole cohort, 327 (29.7%) patients needed mechanical circulatory support (MCS) while on the waiting list, 314 (28.5%) were treated with extracorporeal membrane oxygenation (ECMO) as a bridge, and 13 (1.2%) were treated with a ventricular assist device (VAD) as a bridge. The waiting-list survival rate for ECMO-bridged patients was significantly lower than that for VAD-bridged or non-MCS-bridged patients. The waiting-list survival rate for patients with a status of 0 or 1 was significantly lower than for patients with a status of 2 or 3. Multivariate analysis revealed that the independent risk factors for waiting-list mortality were congenital heart disease and restrictive cardiomyopathy compared with dilated cardiomyopathy, status 0 compared with status 2 and 3, low hemoglobin, history of ventricular arrhythmia, high MELD-XI score, and ECMO bridging during the waiting period.

CONCLUSION

This study showed that ECMO as a bridge to transplantation and status 0 were associated with significantly higher waiting-list mortality. Advanced end-organ damage at the time of listing was also found to be an independent risk factor for waiting-list mortality.