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Influence of intensified medical treatment and organ allocation on outcome of transplant candidates.

BACKGROUND
To test how the organization of a pre-transplant clinic and changes in organ allocation modus influence the survival of potential transplant candidates, the survival of patients referred for transplant evaluation between 4/93 and 4/96 (group A) was compared to that of patients referred from 5/96 to 7/00(group B).


METHODS
After screening for transplant indication, group A was followed by the referring physician up to transplantation or 3-month reevaluation. Group B was closely followed by a specialized heart-failure clinic. Group A was transplanted according to Eurotransplant criteria, with waiting time being the strongest priority criterion. Due to an allocation partnership off our transplant centers, group B could be transplanted according to medical urgency regardless of waiting time.


RESULTS
Overall one-year survival after referral was 69.8% for group A vs. 91 %for group B (p <0.0001). Transplantation within 1 year was required in more group A than group B patients (34% vs. 23%)with worse one-year post-transplant survival in group A (82%vs. 93%).


CONCLUSIONS
Intensified treatment by a specialized heart failure program and an allocation system that allows for preferred transplantation of the 'sickest' patient improved over-all survival of transplant candidates and reduced the percentage of patients requiring transplantation.