BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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: Eileen M Hsich; Lucy Thuita; Dennis M McNamara; Joseph G Rogers; Maryam Valapour; Lee R Goldberg; Clyde W Yancy; Eugene H Blackstone; Hemant Ishwaran Journal: Am J Transplant Date: 2019-02-13 Impact factor: 8.086
Authors: Guillaume Baudry; Juliette Bourdin; Raluca Mocan; Elisabeth Hugon-Vallet; Matteo Pozzi; Antoine Jobbé-Duval; Nicolas Paulo; Patrick Rossignol; Laurent Sebbag; Nicolas Girerd Journal: J Clin Med Date: 2022-06-24 Impact factor: 4.964
Authors: William F Parker; Nicole E Dussault; Renea Jablonski; Edward R Garrity; Matthew M Churpek Journal: J Heart Lung Transplant Date: 2021-10-28 Impact factor: 13.569
Authors: Eugene H Blackstone; Jeevanantham Rajeswaran; Vincent B Cruz; Eileen M Hsich; Marijan Koprivanac; Nicholas G Smedira; Katherine J Hoercher; Lucy Thuita; Randall C Starling Journal: J Am Coll Cardiol Date: 2018-08-07 Impact factor: 24.094
Authors: William F Parker; Allen S Anderson; Robert D Gibbons; Edward R Garrity; Lainie F Ross; Elbert S Huang; Matthew M Churpek Journal: JAMA Date: 2019-11-12 Impact factor: 56.272
Authors: Gege Ran; Kevin Chung; Allen S Anderson; Robert D Gibbons; Nikhil Narang; Matthew M Churpek; William F Parker Journal: Am J Transplant Date: 2021-05-05 Impact factor: 8.086
Authors: Louise Y Sun; Harindra C Wijeysundera; Douglas S Lee; Sean van Diepen; Marc Ruel; Anan Bader Eddeen; Thierry G Mesana Journal: CMAJ Open Date: 2022-03-08