A prognostic model for predicting waiting-list mortality for a total national cohort of adult heart-transplant candidates.
BACKGROUND
Current trends in medical management of advanced heart failure and transplant medicine and the enactment of a national transplant law forced a change toward allocation driven by disease severity.


OBJECTIVE
The aim of this study was to create a model for predicting waiting-list survival on the basis of simple clinical parameters.


METHODS
The clinical profiles of all patients registered for heart transplantation in Germany in 1997 (n=889) were used as a derivation set, and the total German 1998 cohort (n=897) was used as a validation set. The model was validated by the c statistic and by comparison of risk stratified mortality rates. The validated model was fine tuned by the appropriate calibration procedures. The data were first classified into physiologic subscores: an urgency score, a left ventricular heart failure score, a right ventricular heart failure score, and a systemic heart failure score. A stepwise modeling procedure was undertaken using these subscores as factors as well as the recipient's age, ABO blood group, and body surface area.


RESULTS
The urgency and the left ventricular subscore were found to be significantly associated with waiting-list mortality. A summary index termed German Transplant Society (GTS) score was then calculated on the basis of seven parameters contained in these two subscores. The GTS score was able to predict waiting-list mortality risks for the 1998 cohort: 1-year mortality before transplantation was 71%, 34%, 11% for the high, medium, and low risk groups, respectively.


CONCLUSIONS
The use of this continuous disease severity index may improve the selection of cardiac transplant candidates.
Eurotransplant International Foundation, Leiden, The Netherlands. JSMITS@EUROTRANSPLANT.NL.
Jacqueline M A
JM
Smits
Mario C
MC
Deng
Manfred
M
Hummel
Johan
J
De Meester
Friedrich
F
Schoendube
Hans H
HH
Scheld
Guido G
GG
Persijn
Gunther
G
Laufer
Hans C
HC
Van Houwelingen
D000328:Adult; D002303:Cardiac Output, Low / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005858:Germany; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D018579:Patient Selection; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D018487:Ventricular Dysfunction, Left / Q000150:complications; D018497:Ventricular Dysfunction, Right / Q000150:complications; D014850:Waiting Lists