Removal from the "waiting list" for heart transplantation: A risk factor for sudden death?

Methods and Results: Over an 18-month period, the patients on the heart transplantation waiting list at our institution were evaluated to determine if continued listing was appropriate. Ten patients were removed because of significant improvement in clinical status and exercise capacity (n = 9) or because of criteria violation (n = 1). Four of these patients died suddenly and unexpectedly within 4 months of delisting, resulting in a 6-month survival of 60% for the patients removed. During the same period, the 6-month survival for newly listed patients (n = 10) was 80% and that for newly transplanted patients (n = 13) was 92%. An elevated pulmonary capillary wedge pressure (≥18 mmHg) was the only clinical or laboratory feature that appeared to distinguish the four patients who died suddenly following delisting. Conclusion: The results of this preliminary study suggest that removal of a patient from a heart transplant waiting list may represent a risk for sudden death, particularly in patients with elevated ventricular filling pressures, irrespective of otherwise favorable clinical status and exercise performance.