Development of a quantitative donor risk index to predict short-term mortality in orthotopic heart transplantation

Weiss, Eric S.; Allen, Jeremiah G.; Kilic, Arman; Russell, Stuart D.; Baumgartner, William A.; Conte, John V.; Shah, Ashish S.

doi:10.1016/j.healun.2011.10.004

Cited by 145 publications

(144 citation statements)

References 16 publications

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“…8,9 The recipient and donor risk scores were calculated for each OHT recipient. The average IMPACT score and donor risk score at the center level were then determined by calculating the mean scores of all of the recipients and their respective donors at that center.…”

Section: Discussionmentioning

confidence: 99%

“…6 The expected mortality based on donor risk was calculating by inputting the average donor risk score of donors at a center into the following equation, which was generated from the predictive model in the original UNOS cohort: estimated 1-year mortality = 10.024 × [e^(0.0847 × donor risk score)]. 8 Because these risk indexes have similar predictive power in estimating 1-year mortality after OHT, the expected mortalities at the center level were calculated by averaging the estimated 1-year mortalities based on the mean recipient and donor risk scores for the patients at that center. The OE ratio for each center was calculated by dividing the actual 1-year mortality rate at that center by the average expected 1-year mortality.…”

Section: Discussionmentioning

confidence: 99%

“…In examining specific complications, blacks, whites, and Hispanics had similar rates of postoperative new-onset dialysis (blacks 8 …”

Section: Transplant Center Race Distribution and Center-level Mortalitymentioning

confidence: 99%

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Racial Disparities in Outcomes of Adult Heart Transplantation

et al. 2015

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Background— This study evaluated whether minority orthotopic heart transplant (OHT) recipients tend to be transplanted at worse performing centers. Methods and Results— OHT recipients between 2000 and 2010 were identified in the United Network for Organ Sharing database and stratified by race. Center performance was evaluated using observed-to-expected mortality ratios that were calculated using validated indexes for recipient and donor risk in OHT. The primary outcome was 1-year post-OHT mortality. A total of 102 centers performed OHT in 18 085 patients. Blacks had higher unadjusted 1-year mortality, which was confirmed after risk adjustment. Blacks had increased risk-adjusted mortality at poor performing centers (observed-to-expected mortality ratio, >1.2; odds ratio, 1.37 [95% confidence interval, 1.12–1.69]; P =0.002) and a strong trend toward increased mortality at excellent performing centers (observed-to-expected mortality ratio, <0.8; odds ratio, 1.42 [95% confidence interval, 0.99–2.02]; P =0.06). A higher proportion of blacks were treated at centers with higher-than-expected mortality (56.4% versus 47.1% whites versus 48.1% Hispanics; P <0.001), a finding that persisted after adjusting for insurance type and highest education level. In addition, there was a positive correlation between the percentage of blacks and observed-to-expected mortality ratios at the center level ( r =0.32; P =0.001). In multivariable analysis incorporating immunologic and socioeconomic variables, there was no clear dominant source for the disparities in outcomes of OHT between races. Conclusions— Blacks have a propensity to be transplanted at worse performing centers; however, center effect alone does not explain the mortality difference between ethnicities. Although referral of minorities to better performing centers would improve absolute survival, it would not likely eliminate the racial disparities that exist in OHT outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Racial Disparities in Outcomes of Adult Heart Transplantation

et al. 2015

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“…Donor selection remains a challenging and multifactorial decision that is influenced by imperfect donor information (and lack of data on how to interpret this information), a potential candidate's medical urgency, donor-recipient match considerations, and institutional risk tolerance. To date, a number of consensus statements (4,5) and risk models (6,7) have been published in an attempt to codify knowledge around donor heart selection. What we know is that more patients are waiting for heart transplantation every year, that there is a positive association between time spent on the waitlist and mortality (8) and that the criteria used for donor heart selection must be questioned, challenged, and expanded in order to meet the evergrowing demand for heart transplantation.…”

Section: Introductionmentioning

confidence: 99%

Donor selection in the modern era

Khush

2018

Ann. Cardiothorac. Surg.

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The growing disparity between the supply of donor hearts for transplantation and the demand for such organs has led to liberalization of the criteria for donor heart acceptance over the past few decades. The upper age limit and size restrictions for donor heart acceptance continue to be revised and hearts are being routinely used from donors with left ventricular dysfunction, left ventricular hypertrophy (LVH), cocaine use, multiple medical co-morbidities and after cardiopulmonary resuscitation. This article reviews recent data for use of such "expanded criteria" donor hearts and suggests ways to further increase the donor pool, including use of hearts from donors with hepatitis C and after circulatory determination of death. Donor biomarkers and risk scores may eventually aid in heart acceptance decisions, while ethical issues surrounding information sharing with transplant recipients remain a topic of great debate.

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“…These covariates were recipients' age; recipients' sex; sex mismatch; cause of heart failure; presence of diabetes; body mass index (kg/m 2 ); size mismatch (defined as body mass index difference > 20%) 6 ; serum creatinine at the time of transplant; pretransplant location (nonhospitalized, hospitalized, or intensive care unit); inotrope requirement at the time of transplant (yes/no); days on the waitlist; center volume (quantified as a continuous variable, defined as the number of heart or heart/lung transplants performed by the transplant center during the study period); year of transplant; total ischemic time; donor age; donor blood urea nitrogen (mg/dL)/creatinine (mg/dL) ratio; and donor/recipient race mismatch. 7 The primary outcome variable was perioperative and long-term overall survival. For patients in the donor-arrest group, a secondary analysis was performed to assess the association between duration of arrest time and post-transplant survival.…”

Section: Methodsmentioning

confidence: 99%