Prediction of Waitlist Mortality in Adult Heart Transplant Candidates: The Candidate Risk Score

Jasseron, Carine; Legeai, Camille; Jacquelinet, Christian; Leprince, Pascal; Cantrelle, C.; Audry, Benoît; Lanoy, Émilie; Porcher, Raphaël; Bastien, Olivier; Dorent, Richard

doi:10.1016/j.healun.2017.01.292

Cited by 23 publications

(28 citation statements)

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“…The study was single‐centre; however, results on waiting‐list mortality showed that the cohort behaved akin to larger cohorts of HF patients. Indeed, variables associated with mortality in this study were also similar to that of the recent Candidate Risk Score (CRS) assessing 1‐year mortality after listing, based on the overall Cristal database registry .…”

Section: Discussionmentioning

confidence: 54%

“…In this sense, the work started by Jasseron et al . , on a national risk score, may be the first step towards such change in practices. The next logical step would be the inclusion of centre‐specific adjustment factors to account for centre‐scale, although this would require more statistical power which heart transplantation does not necessarily allow, yet.…”

Section: Discussionmentioning

confidence: 99%

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Performance of existing risk scores around heart transplantation: validation study in a 4-year cohort

et al. 2018

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Several risk scores exist to help identify best candidate recipients for heart transplantation (HTx). This study describes the performance of five heart failure risk scores and two post-HTx mortality risk scores in a French single-centre cohort. All patients listed for HTx through a 4-year period were included. Waiting-list risk scores [Heart Failure Survival Score (HFSS), Seattle Heart Failure Model (SHFM), Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC), Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) and Get With The Guidelines-Heart Failure (GWTG-HF)] and post-HTx scores Index for Mortality Prediction After Cardiac Transplantation (IMPACT and CARRS) were computed. Main outcomes were 1-year mortality on waiting list and after HTx. Performance was assessed using receiver operator characteristic (ROC), calibration and goodness-of-fit analyses. The cohort included 414 patients. Waiting-list mortality was 14.0%, and post-HTx mortality was 16.3% at 1-year follow-up. Heart failure risk scores had adequate discrimination regarding waiting-list mortality (ROC AUC for HFSS = 0.68, SHFM = 0.74, OPTIMIZE-HF = 0.72, MAGGIC = 0.70 and GWTG = 0.77; all P-values <0.05). On the contrary, post-HTx risk scores did not discriminate post-HTx mortality (AUC for IMPACT = 0.58, and CARRS = 0.48, both P-values >0.50). Subgroup analysis on patients undergoing HTx after ventricular assistance device (VAD) implantation (i.e. bridge-to-transplantation) (n = 36) showed an IMPACT AUC = 0.72 (P < 0.001). In this single-centre cohort, existing heart failure risk scores were adequate to predict waiting-list mortality. Post-HTx mortality risk scores were not, except in the VAD subgroup.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Performance of existing risk scores around heart transplantation: validation study in a 4-year cohort

et al. 2018

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“…The current challenge is to identify non-invasive biomarkers that enable the early stratification of patients at risk 2,[5][6][7][8] to tailor individualized therapeutic approaches that prevent HT failure 6,9 .…”

Section: Downloaded Frommentioning

confidence: 99%

Genetic and Functional Profiling of CD16-Dependent Natural Killer Activation Identifies Patients at Higher Risk of Cardiac Allograft Vasculopathy

et al. 2018

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“…Since 2004, the heart allocation system in France has been based on medical urgency and geography, without considering posttransplant mortality . We recently developed a candidate‐risk score (CRS) from the French national transplant database based on the candidate's characteristics, rather than treatment modalities, that provides an objective prediction of waitlist mortality . The CRS has been incorporated into a modified urgency‐based allocation system.…”

Section: Introductionmentioning

confidence: 99%

Optimization of heart allocation: The transplant risk score

Jasseron

Legeai

Jacquelinet

et al. 2019

American Journal of Transplantation

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The new French heart allocation system is designed to minimize waitlist mortality and extend the donor pool without a detrimental effect on posttransplant survival. This study was designed to construct a 1‐year posttransplant graft‐loss risk score incorporating recipient and donor characteristics. The study included all adult first single‐organ recipients transplanted between 2010 and 2014 (N = 1776). This population was randomly divided in a 2:1 ratio into derivation and validation cohorts. The association of variables with 1‐year graft loss was determined with a mixed Cox model with center as random effect. The predictors were used to generate a transplant‐risk score (TRS). Donor‐recipient matching was assessed using 2 separate recipient‐ and donor‐risk scores. Factors associated with 1‐year graft loss were recipient age >50 years, valvular cardiomyopathy and congenital heart disease, previous cardiac surgery, diabetes, mechanical ventilation, glomerular filtration rate and bilirubin, donor age >55 years, and donor sex: female. The C‐index of the final model was 0.70. Correlation between observed and predicted graft loss rate was excellent for the overall cohort (r = 0.90). Hearts from high‐risk donors transplanted to low‐risk recipients had similar survival as those from low‐risk donors. The TRS provides an accurate prediction of 1‐year graft‐loss risk and allows optimal donor‐recipient matching.

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Prediction of Waitlist Mortality in Adult Heart Transplant Candidates: The Candidate Risk Score

Cited by 23 publications

References 0 publications

Performance of existing risk scores around heart transplantation: validation study in a 4-year cohort

Performance of existing risk scores around heart transplantation: validation study in a 4-year cohort

Genetic and Functional Profiling of CD16-Dependent Natural Killer Activation Identifies Patients at Higher Risk of Cardiac Allograft Vasculopathy

Optimization of heart allocation: The transplant risk score

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