Severe right ventricular dysfunction is an independent predictor of pre- and post-transplant mortality among candidates for heart transplantation

Summary Background Heart transplantation is the gold-standard treatment for end-stage heart failure. However, the shortage of grafts has led to longer waiting times and increased mortality for candidates without priority. Aims To study waiting-list and post-transplant mortality, and their risk factors among patients registered for heart transplantation without initial high emergency procedure. Methods All patients registered on the heart transplantation waiting list (2004–2015) without initial high emergency procedure were included. Clinical, biological, echocardiographic and haemodynamic data were collected. Waiting list and 1-year post-transplant survival were analysed with a Kaplan-Meier model. Results Of 221 patients enrolled, 168 (76.0%) were men. Mean age was 50.0 ± 12.0 years. Forty-seven patients died on the waiting list, resulting in mortality rates of 11.2 ± 2.7% at 1 year, 31.9 ± 5.4% at 2 years and 49.4 ± 7.1% at 3 years. Median survival was 36.0 ± 4.6 months. In the multivariable analysis, left ventricular ejection fraction  P  = 0.010) and severe right ventricular systolic dysfunction (HR: 2.89, 95% CI: 1.41–5.92; P  = 0.004) were associated with increased waiting-list mortality. The post-transplant survival rate was 73.1 ± 4.4% at 1 year. Pretransplant severe right ventricular dysfunction and age > 50 years were strong predictors of death after transplantation (HR: 5.38, 95% CI: 1.38–10.24 [ P  = 0.020] and HR: 6.16, 95% CI: 1.62–9.32 [ P  = 0.0130], respectively). Conclusions Mortality among candidates for heart transplantation remains high. Patients at highest risk of waiting-list mortality have to be promoted, but without compromising post-transplant outcomes. For this reason, candidates with severe right ventricular dysfunction are of concern, because, for them, transplantation is hazardous.