Heart transplantation in the United States, 1998-2007.

This article highlights trends in heart transplantation from 1998 to 2007, using data from the Organ Procurement and Transplantation Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR). The number of candidates actively awaiting heart transplantation has declined steadily, from 2525 in 1998 to 1408 in 2007, a 44% decrease. Despite this decline, a larger proportion of patients are listed as either Status 1A or 1B, likely secondary to increased use of mechanical circulatory support. During this time, the overall death rate among patients awaiting heart transplantation fell from 220 to 142 patients per 1000 patient-years at risk; this likely reflects better medical and surgical options for those with end-stage heart failure. This trend was noted across all racial groups, both sexes, all disease etiologies (retransplantation excepted) and all status groups. Recipient numbers were relatively stable over the past decade. In 2007, 2207 transplants were performed, although the proportion of patients transplanted as Status 1A shifted from 34% to 50%. A trend toward transplanting more patients above 65 years of age was seen. Adjusted patient (and graft) survival at 3 months, 1, 5 and 10 years after transplantation has gradually, but significantly, improved during the same period; current patient survival estimates are 93%, 88%, 74% and 55%, respectively.