title: Preoperative assessment of high-risk candidates to predict survival after heart transplantation.
abstract: BACKGROUND
  Alternate waiting list strategies expand listing criteria for patients awaiting heart transplantation (HTx). We retrospectively analyzed clinical events and outcome of patients listed as high-risk recipients for HTx.
  
  
  RESULTS
  We analyzed 822 adult patients who underwent HTx of whom 111 patients met high-risk criteria. Clinical data were collected from medical records and outcome factors calculated for 61 characteristics. Significant factors were summarized in a prognostic score. Age >65 years (67%) and amyloidosis (19%) were the most common reasons for alternate listing. High-risk recipients were older (63.2±10.2 versus 51.4±11.8 years; P<0.001), had more renal dysfunction, prior cancer, and smoking. Survival analysis revealed lower post-HTx survival in high-risk recipients (82.2% versus 87.4% at 1-year; 59.8% versus 76.3% at 5-year post-HTx; P=0.0005). Prior cerebral vascular accident, albumin <3.5 mg/dL, re-HTx, renal dysfunction (glomerular filtration rate <40 mL/min), and >2 prior sternotomies were associated with poor survival after HTx. A prognostic risk score (CARRS [CVA, albumin, re-HTx, renal dysfunction, and sternotomies]) derived from these factors stratified survival post-HTx in high-risk (3+ points) versus low-risk (0-2 points) patients (87.9% versus 52.9% at 1-year; 65.9% versus 28.4% at 5-year post-HTx; P<0.001). Low-risk alternate patients had survival comparable with regular patients (87.9% versus 87.0% at 1-year and 65.9% versus 74.5% at 5-year post-HTx; P=0.46).
  
  
  CONCLUSIONS
  High-risk patients had reduced survival compared with regular patients post-HTx. Among patients previously accepted for alternate donor listing, application of the CARRS score identifies patients with unacceptably high mortality after HTx and those with a survival similar to regularly listed patients.
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY 10032, USA. pcs2121@mail.cumc.columbia.edu
authors.forename: P Christian
authors.initials: PC
authors.lastname: Schulze
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jiang
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yang
authors.forename: Faisal H
authors.initials: FH
authors.lastname: Cheema
authors.forename: Kenneth
authors.initials: K
authors.lastname: Schaeffle
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.forename: Maryjane
authors.initials: M
authors.lastname: Farr
authors.forename: Susan
authors.initials: S
authors.lastname: Restaino
authors.forename: Mario
authors.initials: M
authors.lastname: Deng
authors.forename: Mathew
authors.initials: M
authors.lastname: Maurer
authors.forename: Evelyn
authors.initials: E
authors.lastname: Horn
authors.forename: Farhana
authors.initials: F
authors.lastname: Latif
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.forename: Ulrich
authors.initials: U
authors.lastname: Jorde
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.forename: Jennifer
authors.initials: J
authors.lastname: Haythe
authors.forename: Rachel
authors.initials: R
authors.lastname: Bijou
authors.forename: Ron
authors.initials: R
authors.lastname: Drusin
authors.forename: Sun Hi
authors.initials: SH
authors.lastname: Lee
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
mesh_terms: D000328:Adult; D000686:Amyloidosis / Q000150:complications; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors
keywords: heart failure; prognosis; transplantation