title: Prediction of Waitlist Mortality in Adult Heart Transplant Candidates: The Candidate Risk Score.
abstract: The cardiac allocation system in France is currently based on urgency and geography. Medical urgency is defined by therapies without considering objective patient mortality risk factors. This study aimed to develop a waitlist mortality risk score from commonly available candidate variables.
  
  
  
  The study included all patients, aged 16 years or older, registered on the national registry CRISTAL for first single-organ heart transplantation between January 2010 and December 2014. This population was randomly divided in a 2:1 ratio into derivation and validation cohorts. The association of variables at listing with 1-year waitlist death or delisting for worsening medical condition was assessed within the derivation cohort. The predictors were used to generate a candidate risk score (CRS). Validation of the CRS was performed in the validation cohort. Concordance probability estimation (CPE) was used to evaluate the discriminative capacity of the models.
  
  
  
  During the study period, 2333 patients were newly listed. The derivation (n =1 555) and the validation cohorts (n = 778) were similar. Short-term mechanical circulatory support, natriuretic peptide decile, glomerular filtration rate, and total bilirubin level were included in a simplified model and incorporated into the score. The Concordance probability estimation of the CRS was 0.73 in the derivation cohort and 0.71 in the validation cohort. The correlation between observed and expected 1-year waitlist mortality in the validation cohort was 0.87.
  
  
  
  The candidate risk score provides an accurate objective prediction of waitlist mortality. It is currently being used to develop a modified cardiac allocation system in France.
authors.affiliation: 1 Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France. 2 Assistance Publique Hôpitaux de Paris, Service de chirurgie cardio-vasculaire, Hôpital de la Pitié Salpêtrière, Paris, France. 3 Assistance Publique Hôpitaux de Paris, Hôtel-Dieu, Centre d'Epidémiologie Clinique, Université Paris Descartes, Inserm U1153, Paris, France.
authors.forename: Carine
authors.initials: C
authors.lastname: Jasseron
authors.forename: Camille
authors.initials: C
authors.lastname: Legeai
authors.forename: Christian
authors.initials: C
authors.lastname: Jacquelinet
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Christelle
authors.initials: C
authors.lastname: Cantrelle
authors.forename: Benoît
authors.initials: B
authors.lastname: Audry
authors.forename: Raphael
authors.initials: R
authors.lastname: Porcher
authors.forename: Olivier
authors.initials: O
authors.lastname: Bastien
authors.forename: Richard
authors.initials: R
authors.lastname: Dorent
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D003661:Decision Support Techniques; D016002:Discriminant Analysis; D005260:Female; D005602:France; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D045265:Natriuretic Peptides / Q000097:blood; D011237:Predictive Value of Tests; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D014850:Waiting Lists / Q000401:mortality*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides; D001663:Bilirubin