Risk factors for early death in patients awaiting heart-lung or lung transplantation: Experience at a single European center

Background. Our purpose was to establish whether patients on the waiting list for heart-lung or lung transplantation had different survival rates according to diagnosis and to determine the specific variables responsible for early death. Methods. Between 1988 and 1996, 278 patients were placed on the waiting list for organ transplant. Diagnoses were pulmonary vascular disease in 128, parenchymal disease in 141, and retransplantation in 9 patients. Eighty patients received transplants, 100 patients died awaiting transplantation, and 98 patients are still awaiting transplantation. Univariate and multivariate analyses of risk factors for early death on the waiting list were performed. Patients still listed ≤6 months (n=24), transplanted ≤6 months (n=37), or in the retransplantation group (n=9) were excluded. Of the remaining 208 patients, 52 died ≤6 months and 156 survived >6 months. Results. Patients with primary pulmonary hypertension, pulmonary fibrosis, or cystic fibrosis had statistically significantly lower survival rates at 6, 12, and 24 months (31%, 36% and 26%, respectively at 24 months) than patients with Eisenmenger's syndrome and chronic obstructive pulmonary disease (76% and 71%). Patients with Eisenmenger's syndrome who died ≤6 months had significantly higher systolic pulmonary artery pressure (134±39 vs. 108±25 mmHg) and pulmonary vascular resistence (1928±1686 vs. 1191±730 dyn/sec/cm^-5) than those who survived longer. Patients with pulmonary fibrosis who died ≤6 months had significantly lower forced vital capacity (36±15 vs. 47±13% predicted), forced expiratory volume (37±14 vs. 48±14% predicted), room air pO₂ (42±11 vs. 50±11 mmHg), and room air O₂- saturation (78±10 vs. 84±8%) than those who survived longer. In the multivariate analysis, only the type of pathology was a significant risk factor for death after being on the waiting list ≤6 months. Conclusions. Certain pathologies and variables are risk factors for early death in patients on the waiting list. This information may be used to allocate specific donor organs to patients in greater need.