Eileen M Hsich1, Eugene H Blackstone2, Lucy W Thuita3, Dennis M McNamara4, Joseph G Rogers5, Clyde W Yancy6, Lee R Goldberg7, Maryam Valapour8, Gang Xu9, Hemant Ishwaran10. 1. Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio. Electronic address: Hsiche@ccf.org. 2. Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. 3. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. 4. University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 5. Division of Cardiology, Duke University, Durham, North Carolina. 6. Division of Cardiology, Northwestern University Medical Center, Chicago, Illinois. 7. Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 8. Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio. 9. Division of Biostatistics, University of Miami, Miami, Florida. 10. Division of Biostatistics, University of Miami, Miami, Florida; Department of Public Health Sciences, University of Miami, Miami, Florida.
Abstract
OBJECTIVES: This study aims to understand the complex factors affecting heart transplant survival and to determine the importance of possible sex-specific risk factors. BACKGROUND: Heart transplant allocation is primarily focused on preventing waitlist mortality. To prevent organ wastage, future allocation must balance risk of waitlist mortality with post-transplantation mortality. However, more information regarding risk factors after heart transplantation is needed. METHODS: We included all adults (30,606) in the Scientific Registry of Transplant Recipients database who underwent isolated heart transplantation from January 1, 2004, to July 1, 2018. Mortality (8,278 deaths) was verified with the complete Social Security Death Index with a median follow-up of 3.9 years. Temporal decomposition was used to identify phases of survival and phase-specific risk factors. The random survival forests method was used to determine importance of mortality risk factors and their interactions. RESULTS: We identified 3 phases of mortality risk: early post-transplantation, constant, and late. Sex was not a significant risk factor. There were several interactions predicting early mortality such as pretransplantation mechanical ventilation with presence of end-organ function (bilirubin, renal function) and interactions predicting later mortality such as diabetes and older age (donor and recipient). More complex interactions predicting early-, mid-, and late-mortality existed and were identified with machine learning (i.e., elevated bilirubin, mechanical ventilation, and dialysis). CONCLUSIONS: Post-heart transplant mortality risk is complex and dynamic, changing with time and events. Sex is not an important mortality risk factor. To prevent organ wastage, end-organ dysfunction should be resolved before transplantation as much as possible.
OBJECTIVES: This study aims to understand the complex factors affecting heart transplant survival and to determine the importance of possible sex-specific risk factors. BACKGROUND: Heart transplant allocation is primarily focused on preventing waitlist mortality. To prevent organ wastage, future allocation must balance risk of waitlist mortality with post-transplantation mortality. However, more information regarding risk factors after heart transplantation is needed. METHODS: We included all adults (30,606) in the Scientific Registry of Transplant Recipients database who underwent isolated heart transplantation from January 1, 2004, to July 1, 2018. Mortality (8,278 deaths) was verified with the complete Social Security Death Index with a median follow-up of 3.9 years. Temporal decomposition was used to identify phases of survival and phase-specific risk factors. The random survival forests method was used to determine importance of mortality risk factors and their interactions. RESULTS: We identified 3 phases of mortality risk: early post-transplantation, constant, and late. Sex was not a significant risk factor. There were several interactions predicting early mortality such as pretransplantation mechanical ventilation with presence of end-organ function (bilirubin, renal function) and interactions predicting later mortality such as diabetes and older age (donor and recipient). More complex interactions predicting early-, mid-, and late-mortality existed and were identified with machine learning (i.e., elevated bilirubin, mechanical ventilation, and dialysis). CONCLUSIONS:Post-heart transplant mortality risk is complex and dynamic, changing with time and events. Sex is not an important mortality risk factor. To prevent organ wastage, end-organ dysfunction should be resolved before transplantation as much as possible.
Authors: Clyde W Yancy; Mariell Jessup; Biykem Bozkurt; Javed Butler; Donald E Casey; Mark H Drazner; Gregg C Fonarow; Stephen A Geraci; Tamara Horwich; James L Januzzi; Maryl R Johnson; Edward K Kasper; Wayne C Levy; Frederick A Masoudi; Patrick E McBride; John J V McMurray; Judith E Mitchell; Pamela N Peterson; Barbara Riegel; Flora Sam; Lynne W Stevenson; W H Wilson Tang; Emily J Tsai; Bruce L Wilkoff Journal: J Am Coll Cardiol Date: 2013-06-05 Impact factor: 24.094
Authors: Eileen M Hsich; Eugene H Blackstone; Lucy Thuita; Dennis M McNamara; Joseph G Rogers; Hemant Ishwaran; Jesse D Schold Journal: Circ Heart Fail Date: 2017-06 Impact factor: 8.790
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Authors: P Elliott Miller; Clancy W Mullan; Fouad Chouairi; Sounok Sen; Katherine A Clark; Samuel Reinhardt; Michael Fuery; Muhammad Anwer; Arnar Geirsson; Richard Formica; Joseph G Rogers; Nihar R Desai; Tariq Ahmad Journal: Eur Heart J Acute Cardiovasc Care Date: 2021-10-27