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Multicenter Study
. 2000 Sep 2;321(7260):540-5.
doi: 10.1136/bmj.321.7260.540.

Effect of Receiving a Heart Transplant: Analysis of a National Cohort Entered on to a Waiting List, Stratified by Heart Failure Severity. Comparative Outcome and Clinical Profiles in Transplantation (COCPIT) Study Group

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Free PMC article
Multicenter Study

Effect of Receiving a Heart Transplant: Analysis of a National Cohort Entered on to a Waiting List, Stratified by Heart Failure Severity. Comparative Outcome and Clinical Profiles in Transplantation (COCPIT) Study Group

M C Deng et al. BMJ. .
Free PMC article

Abstract

Objective: To determine whether there is a survival benefit associated with cardiac transplantation in Germany.

Design: Prospective observational cohort study.

Setting: All 889 adult patients listed for a first heart transplant in Germany in 1997.

Main outcome measure: Mortality, stratified by heart failure severity.

Results: Within 1 year after listing, patients with a predicted high risk had the highest global death rate (51% v 32% and 29% for medium and low risk patients respectively; P<0.0001), had the highest risk of dying on the waiting list (32% v 20% and 20%; P=0.0003), and were more likely to receive a transplant (48% v 45% and 41%; P=0.01). Differences between the risk groups in outcome after transplantation did not reach significance (P=0.2). Transplantation was not associated with a reduction in mortality risk for the total cohort, but it did provide a survival benefit for the high risk group.

Conclusion: Cardiac transplantation in Germany is currently associated with a survival benefit only in patients with a predicted high risk of dying on the waiting list. Patients with a predicted low or medium risk have no reduction in mortality risk associated with transplantation; they should be managed with organ saving approaches rather than transplantation.

Figures

Figure 1
Figure 1
Survival of patients after listing for cardiac transplantation, stratified by heart failure survival score (HFSS)
Figure 2
Figure 2
Mortality of patients on waiting list for cardiac transplantation, stratified by heart failure survival score (HFSS)
Figure 3
Figure 3
Probability of receiving a transplant for patients after listing for cardiac transplantation, stratified by heart failure survival score (HFSS)
Figure 4
Figure 4
Survival after receiving a cardiac transplant for patients stratified by heart failure survival score (HFSS)
Figure 5
Figure 5
Relative risk of death for patients after receiving a cardiac transplant, stratified by heart failure survival score (HFSS)

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