Abstract 13812: Preoperative Risk Assessment of High Risk Heart Transplantation Candidates to Predict Survival Following Heart Transplantation
BACKGROUND. Alternate waiting list strategies expand listing criteria for patients (pts) awaiting heart transplantation (HTx). We retrospectively analyzed clinical events and outcome of pts listed as “high risk” recipients for HTx.
METHODS. 769 adult pts underwent HTx at Columbia University between 1999 and 2010. 111 patients met high risk criteria. Preoperative laboratory, medical history, donor characteristics, perioperative events and postoperative outcome were collected from medical records. Univariate and multivariate proportional hazard ratios were calculated for 61 characteristics to identify factors associated with survival after HTx. Significant factors were summarized in a prognostic score for prediction of survival after HTx.
RESULTS. Contraindications to standard listing included age > 65 years (67%), amyloidosis (11%), advanced diabetes mellitus and peripheral vascular disease (7%), human immunodeficiency virus (4%) and high-risk re-transplant (6%). High risk recipients were older (61±10 vs 54±12 yrs in regular pts; p<0.001), had more renal dysfunction or prior cancer and smoking. Survival analysis revealed lower posttransplant survival in high risk compared to regular listed recipients (82% vs 87% at 1-yr; 60% vs 76% at 5-yrs post-HTx; p<0.005). Prior CVA, Albumin<3.5 mg/dL, Re-HTx, Renal dysfunction (GFR<40 ml/min) and >2 prior Sternotomies were the key factors associated with poor survival following HTx. A prognostic risk score (CARRS) derived from these factors (with each factor assigned 2 points except 1 point for GFR) effectively stratified high risk (3+ points) versus low risk (0-2 points) pts in regard to survival following HTx (88% vs 53% at 1-yr; 66% vs 28% at 5-yrs post-HTx; p<0.001). These low risk alternative patients had survival post-HTx comparable to regular list patients (88% vs 87% at 1-yr; 66% vs 76% at 5-yrs post-HTx; p=NS).
CONCLUSIONS. High risk pts had reduced survival compared to regularly listed pts. Risk stratification using a noninvasive model (CARRS) allows identification of pts with unacceptably high mortality following HTx and those with a survival comparable to regularly listed patients. Application of this model to high risk candidates would eliminate need for alternate list strategies.
- © 2011 by American Heart Association, Inc.