Validation of cause of death classification after heart transplantation and cause‐specific life expectancy compared to the general population

Abstract

Background Post heart‐transplant survival has increased, but information is lacking on specific causes of death and life expectancy. We aimed to assess cause‐specific loss of life‐years compared to the general population, evaluate classification for cause of death after heart transplantation, and assess validity of cause of death data from the International Society of Heart and Lung Transplant (ISHLT) registry. Methods In this single center study, we included 239 heart recipients transplanted between 1988 and 2019 in Lund, Sweden (n = 239, 50% of the transplanted population where the cause of death was available). Two cardiologists retrospectively assigned causes of death according to a published classification (CLASS) in the 91 recipients who died during follow‐up. Life expectancy was compared to data from the general population. Results Compared to the average Swedish population, life expectancy for heart transplant recipients was 20 years shorter (IQR 12.9–27.2). The largest number of life‐years lost were for deaths due to acute (49 years) and chronic rejection (27 years). Primary graft dysfunction (24 years) accounted for 24% of deaths, followed by malignancy (20 years) and infection (17 years), each accounting for ∼20% of deaths. Use of CLASS revealed moderate inter‐rater agreement (56%) and moderate agreement with the ISHLT registry (62%). Conclusions Survival after heart transplantation was 20 years lower than in the general population. In the young, more life‐years were lost due to acute graft rejection, whereas chronic graft rejection and primary graft failure were more important causes of death in older patients. Agreement was moderate between CLASS and the ISHLT registry classifications.

Trends in underlying causes of death in allogeneic hematopoietic cell transplant recipients over the last decade

“…The CLASS method has already been used in classifying death causes after solid organ transplantation. 13,24 Only 18 deaths (6.2%) were classified with unknown cause of death, showing that use of the CLASS method can lead to less uncertainty about the patients' deaths compared to previous studies. [9][10][11] Another strength of this study is the almost complete follow-up of patients due the unique Danish Civil Registration number which allows linkage of clinical and research data.…”

“…This method secures a precise classification through thorough review of patient medical records by trained investigators and subsequent assessment of complicated cases by transplant specialists. The CLASS method has already been used in classifying death causes after solid organ transplantation 13,24 . Only 18 deaths (6.2%) were classified with unknown cause of death, showing that use of the CLASS method can lead to less uncertainty about the patients' deaths compared to previous studies 9–11 .…”

“…23 The strength of the present study lies in the systematic classification of death causes using the validated CLASS method. 12,24 This method secures a precise classification through thorough review of patient medical records by trained investigators and subsequent assessment of complicated cases by transplant specialists. The CLASS method has already been used in classifying death causes after solid organ transplantation.…”

Rapidly progressive pulmonary hypertension and right ventricular failure in a heart and kidney transplant recipient

“…Young patients who undergo solid‐organ transplantation (SOT) have decreased life expectancy when compared to the general population due to post‐transplantation complications such as acute or chronic graft rejection, infection, and death from malignancy. 6 , 7 There is a nearly 9% risk of developing a noncutaneous nonlymphomatous malignancy at 5 years, and for all malignancies, there is a 30% incidence rate at 10 years of post‐SOT. 8 , 9 Therefore, early detection and screening in post‐transplant patients is imperative to improve long‐term mortality.…”