Preoperative assessment of high-risk candidates to predict survival after heart transplantation

P. Christian Schulze, Jeffrey Jiang, Jonathan Yang, Faisal H. Cheema, Kenneth Schaeffle, Tomoko S. Kato, Maryjane Farr, Susan Restaino, Mario Deng, Mathew Maurer, Evelyn Horn, Farhana Latif, Paolo C. Colombo, Ulrich Jorde, Nir Uriel, Jennifer Haythe, Rachel Bijou, Ron Drusin, Sun Hi Lee, Hiroo TakayamaYoshifumi Naka, Donna M. Mancini

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Background-Alternate waiting list strategies expand listing criteria for patients awaiting heart transplantation (HTx). We retrospectively analyzed clinical events and outcome of patients listed as high-risk recipients for HTx. Methods and Results-We analyzed 822 adult patients who underwent HTx of whom 111 patients met high-risk criteria. Clinical data were collected from medical records and outcome factors calculated for 61 characteristics. Significant factors were summarized in a prognostic score. Age >65 years (67%) and amyloidosis (19%) were the most common reasons for alternate listing. High-risk recipients were older (63.2±10.2 versus 51.4±11.8 years; P<0.001), had more renal dysfunction, prior cancer, and smoking. Survival analysis revealed lower post-HTx survival in high-risk recipients (82.2% versus 87.4% at 1-year; 59.8% versus 76.3% at 5-year post-HTx; P=0.0005). Prior cerebral vascular accident, albumin <3.5 mg/dL, re-HTx, renal dysfunction (glomerular filtration rate <40 mL/min), and >2 prior sternotomies were associated with poor survival after HTx. A prognostic risk score (CARRS [CVA, albumin, re-HTx, renal dysfunction, and sternotomies]) derived from these factors stratified survival post-HTx in high-risk (3+ points) versus low-risk (0-2 points) patients (87.9% versus 52.9% at 1-year; 65.9% versus 28.4% at 5-year post-HTx; P<0.001). Low-risk alternate patients had survival comparable with regular patients (87.9% versus 87.0% at 1-year and 65.9% versus 74.5% at 5-year post-HTx; P=0.46). Conclusions-High-risk patients had reduced survival compared with regular patients post-HTx. Among patients previously accepted for alternate donor listing, application of the CARRS score identifies patients with unacceptably high mortality after HTx and those with a survival similar to regularly listed patients.

Original languageEnglish
Pages (from-to)527-534
Number of pages8
JournalCirculation: Heart Failure
Issue number3
StatePublished - May 2013
Externally publishedYes


  • Heart failure
  • Prognosis
  • Transplantation


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