The Eurotransplant High Urgency heart transplantation program: an option for patients in acute heart failure?

Objective: The Eurotransplant High Urgency (HU) heart transplantation program enables urgent heart transplantation for rapidly deteriorating patients in acute-on-chronic heart failure from the elective waiting list. Do we need to stabilize these critically ill patients before heart transplantation with an assist-device or can they primarily be transplanted with an acceptable outcome?

Material and Methods: Between 2000 and 2004 64 heart transplantations (HTx) (32 elective- and 32 HU-HTx) were performed in our department. After been accepted in an auditing process according to HU-criteria, intensive care patients in NYHA functional class IV (cardiac index 1.7 l/ min/ qm BS) in end-organ failure (creatinine 1.5mg/ dl) and catecholamine dependence (dobutamine 8µg/kg/min) get priority in organ allocation and their data are compaired with data from elective patients from the same period.

Results: HU-requests were accepted in 97%. Two request were not accepted, both patients with contraindications for assist-device implantation died within one week. The HU-patients were 100% in NYHA class IV, 93% of the elective patients in NYHA class III. Waiting time on HU-list was 13 days and 7 of these patients died before HTx. Following heart transplantation 30 days and one year survival rates of the HU-group were 88% and 85% versus 94% and 93% in the elective group.

Conclusions: This study shows that end-stage heart failure patients in the HU-program can be transplanted primarily with good results if an organ is supplied timely. We are still in a position where the HU-program can only manage the organ-shortage, there are still too many patients who die on the waiting-list.