EMERGENCY HEART TRANSPLANTATION OUTCOME: THE ITALIAN EXPERIENCE

BIOLOGIC AND THERAPEUTIC ADVANCES IN HEART TRANSPLANTATION I

C. De cillia¹, S. Venettoni¹, A. Ricci¹, M. Caprio¹, F. Lolli², L. Rizzato¹, A. Tancredi¹, A. Nanni costa^3
1Medical Department, ITALIAN NATIONAL TRANSPLANT CENTRE - ISTITUTO SUPERIORE DI SANITA', ROMA/ITALY, ², Italian National Transplant Centre-CNT, Roma/ITALY, ³, . CNT ISS-Centro Nazionali Trapianti, Roma/ITALY

Body: Introduction
The waiting list for emergency heart transplantation was implemented in Italy in 2005 in order to prioritize most urgent cases to those requiring elective hearttransplantation.
While elective heart transplantation waiting lists are managed by regional and interregional organizations in Italy, emergency heart transplantation waiting list is managed by a Nationalorganization, the Italian National Transplant Centre.
Criteria required to be admitted to the emergency heart transplantation waiting list include:
• Short-term(<1 month) circulatory assistance support (centrifugal pump, ECC)
• Long-term circulatory assistance support complicated
• Total artificial heart support complicated
• Mechanical ventilation support + IABP + Continuous IV infusion of Inotropes
These criteria are uniform in all Italian Heart Transplant Centres.
Whenever a suitable case arises in a Heart Transplant Centre, the first available heart will be offered to that Centre, which has to decide whether to accept the organ within 30 minutes time.

Aim of the study
Aim of this study is to examine the emergency heart transplantation Italian experience from the 1st of January 2008 to the 31st of December 2009, number of demands, number of fulfilled demands,timeliness of organ availability, graft and recipient survival.

Material and methods
The number of patients who were listed for emergency heart transplantation in all Italian Heart Transplant Centres between the 1st of January 2008 and the31st of December 2009 has been examined.
Then the timeliness of heart availability has been assessed.
Afterwards graft and recipient survival of related transplantations which were carried out between 2008 and 2009 have been analyzed and compared with those concerning the sample of elective hearttransplantations carried out between the same period.

Results
From the 1st of January 2008 and the 31st of December 2009, 108 patients were listed for emergency heart transplantation. Table 1 shows these patients divided accordingto emergency cause.

EMERGENCY HEART TRANSPLANTATION CAUSES	2008	2009	TOTAL	%
Congenital cardiomyiopathy	19	12	31	28.7
Idiopathic dilated cardiomyopathy	10	8	18	16.7
Other dilated cardiomyopathy	5	12	17	15.7
Ischemic dilated cardiomyopathy	6	10	16	14.8
Reject	5	5	10	9.3
Other cardiopathy	4	4	8	7.4
Restrictive cardiomyopathy	2	2	4	3.7
Valvular cardiopathy	2	2	4	3.7
TOTAL	53	55	108

65 patients underwent surgery (60.2%).
48 patients did not undergo surgery (44.4%), 35 of them died.
As for organ availability, average waiting time for emergency heart transplantation was 3 days (range 0.1 - 22 days), compared to average waiting time for elective heart transplantation that is 2.47 years.
Graft and recipient survival percentage at 1 year was 76.0 ± 1.06 in emergency heart transplantation, in comparison with graft and recipient survival being 86.8 ± 2.1 and 87.1 ± 2.0 in elective heart transplantation.


Conclusion
Survival rates in emergency heart transplantation are inferior than rates concerning patients undergoing elective transplantation as reported in other studies.
However, the implementation of a national uniform protocol for emergency heart transplantation has guaranteed heart availability at a very short average waiting time, thus allowing the fair management of this procedure.

Disclosure: All authors have declared no conflicts of interest.