Patients on Heart Transplant List with “High-Urgency” Status Develop Major Adverse Events Due to Prolonged Waiting Time

Objectives: Over the last years, the waiting time for patients with “high urgency”-status increased considerably. In Germany, the number of HTx decreased in 2015 to 286, which is a difference of 100 transplants compared with 2010. We analyzed the major adverse events during waiting time in “HU”-status of more than 3 months.

Methods: We evaluated a cohort of 96 patients who were listed for HTx with “HU”-status between 2010 and July of 2016 in our heart center. We identified patients with major adverse events such as clinical deterioration with cardiogenic shock and need of mechanical circulatory support, major bleeding, recurrent formation of thrombus and right heart failure in patients with LVAD, as well as psychosocial disorders.

Results: Of 96 patients who were listed with “HU” status, 15 patients (16%) were associated with major adverse events during prolonged waiting time. Median waiting time was 158 days. In four patients, we had to implant a LVAD due to clinical deterioration. Five patients with ”HU” status on mechanical circulatory support developed serious GI bleeding, recurrent pump thrombosis, right ventricular failure, and uncontrollable infection. Three patients developed psychological crisis and another three patients died due to sepsis and multiorgan dysfunction. In the early second quarter, appear to occur clinical deterioration, while in the fourth quarter occur complications in patients on mechanical circulatory support.

Conclusion: Prolonged waiting time for patients in “HU”-status leads to partially irreversible multiorgan failure and psychosocial crisis. Improvements in allocation are desired to decrease waiting time for seriously ill patients. Furthermore, we have to look forward to identify patients who might benefit from psychological interventions.