Outcome of patients referred for cardiac transplantation.

The outcome of 1,102 patients referred for cardiac transplantation at five centers participating in the National Heart Transplantation Study was examined. Using medical and referral records, patients were tracked from date of referral until they were rejected as transplantation candidates or received a transplant. Overall, 34.6% of all patients referred were eventually accepted for transplantation but, of these, 71.9% underwent the procedure. Of those patients accepted but not undergoing the procedure, the vast majority (58.8%) died awaiting a donor heart; another 30.8% later refused the procedure. Very few patients (2.1%) who were accepted for transplantation were deselected as possible candidates because of improved health status. The number of patients awaiting transplantation at all centers was found to be small at the time of study. The results of the analyses revealed major differences among centers in evaluation procedures, proportion of patients accepted and number of patients receiving a transplant. For example, one center performed transplantation on only 50.0% of all patients it accepted, while another did so in more than 81.0% of such patients. It is concluded that both patient selection and donor supply will remain significant determinants of the outcome of patients referred for cardiac transplantation.