BACKGROUND: Conditional survival (CS) is a dynamic method of survival analysis that provides an estimate of how an individual's future survival probability changes based on time post-transplant, individual characteristics, and post-transplant events. This study sought to provide post-transplant CS probabilities for heart transplant recipients based on different prognostic variables and provide a discussion tool for the providers and the patients. METHODS: Adult heart transplant recipients from January 1, 2004, through October 18, 2018, were identified in the UNOS registry. CS probabilities were calculated using data from Kaplan-Meier survival estimates. RESULTS: CS probability exceeded actuarial survival probability at all times post-transplant. Women had similar short-term, but greater long-term CS than men at all times post-transplant (10-year CS 1.8-11.5% greater [95% CI 1.2-12.9]). Patients with ECMO or a surgical BiVAD had decreased survival at the time of transplant, but their CS was indistinguishable from all others by 1-year post-transplant. Rejection and infection requiring hospitalization during the first year were associated with a persistently decreased CS probability. CONCLUSIONS: In this study, we report differential conditional survival outcomes based on time, patient characteristics, and clinical events post-transplant, providing a dynamic assessment of survival. The survival probabilities will better inform patients and clinicians of future outcomes.
BACKGROUND: Conditional survival (CS) is a dynamic method of survival analysis that provides an estimate of how an individual's future survival probability changes based on time post-transplant, individual characteristics, and post-transplant events. This study sought to provide post-transplant CS probabilities for heart transplant recipients based on different prognostic variables and provide a discussion tool for the providers and the patients. METHODS: Adult heart transplant recipients from January 1, 2004, through October 18, 2018, were identified in the UNOS registry. CS probabilities were calculated using data from Kaplan-Meier survival estimates. RESULTS: CS probability exceeded actuarial survival probability at all times post-transplant. Women had similar short-term, but greater long-term CS than men at all times post-transplant (10-year CS 1.8-11.5% greater [95% CI 1.2-12.9]). Patients with ECMO or a surgical BiVAD had decreased survival at the time of transplant, but their CS was indistinguishable from all others by 1-year post-transplant. Rejection and infection requiring hospitalization during the first year were associated with a persistently decreased CS probability. CONCLUSIONS: In this study, we report differential conditional survival outcomes based on time, patient characteristics, and clinical events post-transplant, providing a dynamic assessment of survival. The survival probabilities will better inform patients and clinicians of future outcomes.
Authors: Emelia J Benjamin; Paul Muntner; Alvaro Alonso; Marcio S Bittencourt; Clifton W Callaway; April P Carson; Alanna M Chamberlain; Alexander R Chang; Susan Cheng; Sandeep R Das; Francesca N Delling; Luc Djousse; Mitchell S V Elkind; Jane F Ferguson; Myriam Fornage; Lori Chaffin Jordan; Sadiya S Khan; Brett M Kissela; Kristen L Knutson; Tak W Kwan; Daniel T Lackland; Tené T Lewis; Judith H Lichtman; Chris T Longenecker; Matthew Shane Loop; Pamela L Lutsey; Seth S Martin; Kunihiro Matsushita; Andrew E Moran; Michael E Mussolino; Martin O'Flaherty; Ambarish Pandey; Amanda M Perak; Wayne D Rosamond; Gregory A Roth; Uchechukwu K A Sampson; Gary M Satou; Emily B Schroeder; Svati H Shah; Nicole L Spartano; Andrew Stokes; David L Tirschwell; Connie W Tsao; Mintu P Turakhia; Lisa B VanWagner; John T Wilkins; Sally S Wong; Salim S Virani Journal: Circulation Date: 2019-03-05 Impact factor: 29.690
Authors: M Colvin; J M Smith; N Hadley; M A Skeans; K Uccellini; R Goff; J Foutz; A K Israni; J J Snyder; B L Kasiske Journal: Am J Transplant Date: 2020-01 Impact factor: 8.086
Authors: Francisco A Arabía; Ryan S Cantor; Devin A Koehl; Vigneshwar Kasirajan; Igor Gregoric; Jaime D Moriguchi; Fardad Esmailian; Danny Ramzy; Joshua S Chung; Lawrence S Czer; Jon A Kobashigawa; Richard G Smith; James K Kirklin Journal: J Heart Lung Transplant Date: 2018-04-26 Impact factor: 10.247
Authors: J Jarcho; D C Naftel; T W Shroyer; J K Kirklin; R C Bourge; M L Barr; D G Pitts; R C Starling Journal: J Heart Lung Transplant Date: 1994 Jul-Aug Impact factor: 10.247
Authors: S H Kubo; D C Naftel; R M Mills; J O'Donnell; R J Rodeheffer; G B Cintron; J L Kenzora; R C Bourge; J K Kirklin Journal: J Heart Lung Transplant Date: 1995 May-Jun Impact factor: 10.247