Analysis of mortality risk factors in patients on the heart transplant waiting list: a retrospective study

Abstract

The aim – to analyze mortality risk factors among patients on the heart transplant waiting list in Ukraine.
Materials and methods. The study included 464 patients who were on the HT waiting list at the State Non-Profit Enterprise «Heart Institute of the Ministry of Health of Ukraine» between 2021 and 2024. Demographic parameters, HF etiology, urgency status, laboratory values, use of mechanical circulatory support (MCS), functional test results, and complications were analyzed. One-year survival was predicted using the Seattle Heart Failure Model (SHFM). Statistical analysis included Student’s t-test, Mann-Whitney test, Pearson’s χ2 test, and logistic regression (p<0.05).
Results. The mean age of patients was 49 (38; 58) years, with males comprising 82.8 % of the cohort. HT was performed in 89 (19.2 %) patients, with an average waiting time of 222±45 days. During the waiting period, 11 (2.73 %) patients required MCS implantation, 8 (1.72 %) developed pulmonary embolism, 53 (11.4 %) experienced congestive pneumonia, 27 (5.82 %) had a stroke, 48 (10.3 %) developed gastrointestinal bleeding, and 29 (6.25 %) required dialysis. The overall mortality rate was 21.1 % (98 patients). Deceased patients were significantly older (54 (40; 63) years vs. 47 (33; 58) years, p=0.011), more frequently classified as NYHA functional class IV (35.7 % vs. 14.8 %, p=0.0001), and were more likely to have a diagnosis of dilated cardiomyopathy (80.6 % vs. 62.8 %, p=0.005). Blood group AB was more prevalent among deceased patients (8.16 % vs. 1.37 %, p=0.0003), as well as a history of cardiac surgery (19.4 % vs. 9.86 %, p=0.010) and a longer waiting time (291 (147; 672) vs. 204 (101; 494) days, p=0.0011). Additionally, intra-aortic balloon pump support was more frequently used in the deceased group (3.06 % vs. 0.00 %, p=0.008), indicating a more critical condition.
Conclusions. The main mortality risk factors among heart transplant waiting list patients in Ukraine include age, NYHA functional class IV, dilated cardiomyopathy, blood group AB, prior cardiac surgery, and longer waiting time.