Clinical status of patients removed from a transplant waiting list rivals that of transplant recipients at significant cost savings

We retrospectively contrasted the medical outcome of patients removed from the heart transplant consideration list because of clinical improvement with that of transplant recipients. Of 60 patients awaiting transplantation, 18 were removed from the list (group A), and 42 required transplant or died (group B). Group A significantly improved regarding exercise oxygen uptake, ejection fraction, and hemodynamics. For more than 2 years after transplantation or “delisting,” both groups had comparable symptoms (New York Heart Association class I to II) and cardiovascular mortality (1 of 18 for group A vs 3 of 32 for group B) but lower hospitalizations for group A (0.5 ± 0.6 of 27 months per patient) versus group B (2.8 ± 2.1 of 23 months per patient) (p = 0.0002). Despite two patients who had been removed from the list requiring transplantation, savings for delisting exceeded $2.2 million. Thus medical therapy allows transplant recipient list removal with clinical improvements sustained for 1 to 3 years at significant cost savings.