{"id":"26f00b149d60","type":"article","url":"https://hartvaat.nl/2026/11/15/vhf-patienten-hebben-vergelijkbare-overleving-na-harttransplantatie-unos-cohort/","title":"VHF-patiënten hebben vergelijkbare overleving na harttransplantatie — UNOS-cohort","title_en":"Valvular heart failure is a distinct heart transplant phenotype with comparable adjusted survival to other heart failure etiologies.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"International journal of cardiology","doi":"10.1016/j.ijcard.2026.134747","source_url":"https://doi.org/10.1016/j.ijcard.2026.134747","authors":["Devon Kelley","Varun Kathawate","Joyce Ho","Andrew Belec","Takahiro Tashima","Kazuhiro Ueno","Jessica Dominic","Pavan Atluri"],"significance":5,"published":"2026-09-14","source_date":"2026-11-15","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/hartfalen-stadiumindeling-nyha/"],"congress":"","summary_en":"A retrospective UNOS cohort study characterizes valvular heart failure (VHF) as a distinct heart transplant phenotype with higher waitlist mortality but comparable post-transplant survival compared to other aetiologies. VHF recipients were older, more frequently female, and had higher rates of prior cardiac surgery, leading to greater ECMO reliance and lower VAD use. Recent allocation framework revisions significantly attenuated the waitlist mortality gap. These findings support early referral and optimisation of VHF patients to maximise transplant eligibility and outcomes.","created":"2026-09-08T00:54:35Z","updated":"2026-09-08T00:54:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een retrospectief cohortonderzoek in de UNOS-database toont aan dat hartfalen door klepziekte (VHF) een afzonderlijk fenotype vormt met hogere wachtlijststerfte, maar vergelijkbare overleving na harttransplantatie ten opzichte van andere oorzaken. VHF-patiënten zijn gemiddeld ouder, vaker vrouw en hebben vaker een eerdere hartchirurgie achter de rug, wat leidt tot een hoger ECMO-gebruik en minder VAD-implantaties. Na aanpassingen in de toewijzingsrichtlijnen verdween het sterfterisico op de wachtlijst grotendeels. Voor de klinische praktijk onderstreept dit het belang van vroegtijdige verwijzing en optimalisatie van VHF-patiënten naar een transplantatiecentrum.","abstract_original":"PURPOSE: Valvular heart failure (VHF) accounts for 1-5% of heart transplant listings. Comparative outcomes relative to other heart failure etiologies remain poorly characterized. This study defines the VHF phenotype and compares waitlist and transplant outcomes to other heart failure recipients. METHODS: This retrospective cohort study uses the UNOS thoracic transplant database to analyze adult, first-time, heart-only listings with a diagnosis of heart disease. Patients were grouped by diagnosis as VHF or non-VHF. The primary outcome was waitlist events; post-transplant survival and outcomes were secondary analyses. Subgroup analysis was performed in the post-2018 allocation era. RESULTS: VHF recipients were older (55.3 vs 54.0 years, P = 0.004), more frequently female (36.1% vs 25.0%, P < 0.001), and had higher rates of prior cardiac surgery (P < 0.001) with greater pulmonary vascular burden. At time of listing, VHF recipients had higher ECMO rates (4.9% vs 2.5%, P < 0.001) and lower VAD use (17.3% vs 31.7%, P < 0.001). VHF diagnosis was not independently associated with transplantation rates (SHR 0.979, P = 0.749) but was associated with a 23% higher rate of waitlist death/too sick to transplant (SHR 1.233, P = 0.005). Post-transplant survival was not significantly different between groups (P = 0.812). Post guideline changes, the waitlist mortality difference was attenuated. CONCLUSION: VHF represents a distinct but transplantable phenotype of heart failure. Although VHF patients faced higher waitlist mortality risk, allocation framework revisions attenuated this difference, and post-transplant survival is comparable to non-VHF recipients. Independent predictors of mortality are patient-level risk factors, supporting early referral and optimization as the primary strategy for outcome improvement in this phenotype."}