The risk of dying within 90 days of being placed on a heart transplant wait-list was 10 times greater for patients with the most risk factors compared with those with the fewest, suggesting a need for revising the current heart allocation system, researchers found.

Using a multivariate model developed to assess survival benefit from heart transplantation, Tajinder P. Singh, MD, and colleagues from Boston Children's Hospital and Harvard Medical School found that the 90-day mortality without heart transplant increased from 1.6% in the lowest-risk transplant candidates in their cohort to 16% in the highest-risk candidates.

Patients with the highest risk of death without a heart transplant were also found to have the highest post-transplant mortality, but sicker patients also derived the highest survival benefit from transplantation, the investigators wrote in the Journal of the American College of Cardiology.

And although the survival benefit associated with heart transplantation generally increased with increasing risk of wait-list mortality, no measurable benefit was seen a year after transplant in many of the study participants at the low end of the risk spectrum.

"These findings suggest that considering survival benefit from heart transplant or improving the stratification of listed patients in prioritizing heart allocation may improve overall outcomes in patients listed for heart transplant," Singh and colleagues wrote, adding that, "these findings support the need for a reexamination and revision of the current heart allocation in the U.S. and suggest one possible approach."

Patients are currently listed in three categories, as status 2, 1B or 1A, based on a standard developed to represent increasing medical urgency, with category 1A representing sicker cases considered to be the most urgent. These groups are then assigned progressively higher priority on the list over time.

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