TY - JOUR
T1 - Who is the high-risk recipient? Predicting mortality after heart transplant using pretransplant donor and recipient risk factors
AU - Hong, Kimberly N.
AU - Iribarne, Alexander
AU - Worku, Berhane
AU - Takayama, Hiroo
AU - Gelijns, Annetine C.
AU - Naka, Yoshifumi
AU - Jeevanandam, Val
AU - Russo, Mark J.
N1 - Funding Information:
We thank UNOS for supplying these data, especially Jennifer L. Wainright, PhD, and Katarina Linden, PhD, for their assistance with our analysis. This work was supported in part by Health Resources and Services Administration contract 231-00-0115. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. This work was supported in part by the National Institutes of Health Training Grant 5T32HL007854-13 (A.I.).
PY - 2011/8
Y1 - 2011/8
N2 - Background: In this study we sought the following: (1) To objectively assess the risk related to various pretransplant recipient and donor characteristics; (2) to devise a preoperative risk stratification score (RSS) based on pretransplant recipient and donor characteristics predicting graft loss at 1 year; and (3) to define different risk strata based on RSS. Methods: The United Network for Organ Sharing provided de-identified patient-level data. Analysis included 11,703 orthotopic heart transplant recipients aged 18 years or greater and transplanted between January 1, 2001 and December 31, 2007. The primary outcome was 1-year graft failure. Multivariable logistic regression analysis (backward p value < 0.20) was used to determine the relationship between pretransplant characteristics and 1-year graft failure. Using the odds ratio for each identified variable, an RSS was devised. The RSS strata were defined by calculating receiver operating characteristic curves and stratum specific likelihood ratios. Results: The strongest negative predictors of 1-year graft failure included the following: right ventricular assist device only, extracorporeal membrane oxygenation, renal failure, extracorporeal left ventricular assist device, total artificial heart, and advanced age. Threshold analysis identified 5 discrete RSS strata: low risk (LR, RSS: < 2.55; n = 3242, 27.7%), intermediate risk (IR, RSS: 2.555.72; n = 6,347, 54.2%), moderate risk (MR, RSS: 5.738.13; n = 1,543, 13.2%), elevated risk (ER, RSS: 8.149.48; n = 310, 2.6%), and high risk (HR, RSS: >9.48; n = 261, 2.2%). The 1-year actuarial survival (%) in the LR, IR, MR, ER, and HR groups were 93.8, 89.2, 81.3, 67.0, and 47.0, respectively. Conclusions: Pretransplant recipient variables significantly influence early and late graft failure after heart transplantation. The RSS may improve organ allocation strategies by reducing the potential negative impact of transplanting candidates who are at a high risk for poor postoperative outcomes.
AB - Background: In this study we sought the following: (1) To objectively assess the risk related to various pretransplant recipient and donor characteristics; (2) to devise a preoperative risk stratification score (RSS) based on pretransplant recipient and donor characteristics predicting graft loss at 1 year; and (3) to define different risk strata based on RSS. Methods: The United Network for Organ Sharing provided de-identified patient-level data. Analysis included 11,703 orthotopic heart transplant recipients aged 18 years or greater and transplanted between January 1, 2001 and December 31, 2007. The primary outcome was 1-year graft failure. Multivariable logistic regression analysis (backward p value < 0.20) was used to determine the relationship between pretransplant characteristics and 1-year graft failure. Using the odds ratio for each identified variable, an RSS was devised. The RSS strata were defined by calculating receiver operating characteristic curves and stratum specific likelihood ratios. Results: The strongest negative predictors of 1-year graft failure included the following: right ventricular assist device only, extracorporeal membrane oxygenation, renal failure, extracorporeal left ventricular assist device, total artificial heart, and advanced age. Threshold analysis identified 5 discrete RSS strata: low risk (LR, RSS: < 2.55; n = 3242, 27.7%), intermediate risk (IR, RSS: 2.555.72; n = 6,347, 54.2%), moderate risk (MR, RSS: 5.738.13; n = 1,543, 13.2%), elevated risk (ER, RSS: 8.149.48; n = 310, 2.6%), and high risk (HR, RSS: >9.48; n = 261, 2.2%). The 1-year actuarial survival (%) in the LR, IR, MR, ER, and HR groups were 93.8, 89.2, 81.3, 67.0, and 47.0, respectively. Conclusions: Pretransplant recipient variables significantly influence early and late graft failure after heart transplantation. The RSS may improve organ allocation strategies by reducing the potential negative impact of transplanting candidates who are at a high risk for poor postoperative outcomes.
UR - http://www.scopus.com/inward/record.url?scp=79960970389&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2011.02.086
DO - 10.1016/j.athoracsur.2011.02.086
M3 - Article
C2 - 21683337
AN - SCOPUS:79960970389
VL - 92
SP - 520
EP - 527
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 2
ER -