학술논문

Donor–recipient risk assessment tools in heart transplant recipients: the Bad Oeynhausen experience
Document Type
article
Source
ESC Heart Failure, Vol 8, Iss 6, Pp 4843-4851 (2021)
Subject
Heart transplantation
Mortality
Survival
Risk adjustment
c‐statistics
Diseases of the circulatory (Cardiovascular) system
RC666-701
Language
English
ISSN
2055-5822
Abstract
Abstract Aims Some risk assessment tools have been developed to categorize mortality risk in heart transplant recipients, but it is unclear whether these tools can be used interchangeable in different transplant regions. Methods and results We performed a retrospective single‐centre study in 1049 adult German heart transplant recipients under jurisdiction of Eurotransplant. Univariable and multivariable Cox regression analysis was used to generate a risk scoring system. C‐statistics were used to compare our score with a US score and a French score regarding their ability to discriminate between 1 year survivors and non‐survivors within our study cohort. Of 38 parameters assessed, seven recipient‐specific parameters [age, height, dilated cardiomyopathy (DCM), ischaemic cardiomyopathy (ICM), total bilirubin, extracorporeal membrane oxygenation (ECMO), and biventricular assist device/total artificial heart (BVAD/TAH) implant], one donor‐specific parameter (cold ischaemic time), and one recipient‐independent and donor‐independent other parameter (late transplant era) were statistically significant in predicting 1 year mortality. The initial score was generated by using the regression coefficients from the multivariable analysis as follows: 1.70 * ln age − 4.0 * ln height − 0.9 * diagnosis (= 1 if diagnosis = DCM) − 0.67 * diagnosis (= 1 if diagnosis = ICM) + 0.33 * ln total bilirubin + 1.74 * ln cold ischaemic time + 0.98 * mechanical circulatory support (MCS) implant (= 1 if MCS implant = ECMO) + 0.47 * MCS implant (= 1 of MCS implant = BVAD/TAH) − 0.66 * transplant era (= 1 if transplant era = 2017–2018). The initial score was converted into the Bad Oeynhausen (BO) score as a positive integer variable by means of the following formula: BO score = (initial score + 8) * 3. In patients scoring 2 to