Abstract 16915: Preoperative Risk Assessment of Patients with Advanced Heart Failure Evaluated for Cardiac Transplantation to Predict Survival Following Heart Transplantation
Background: Heart transplantation (HTx) is the only curative treatment of patients with advanced heart failure (HF) but is of limited availability due to severe organ shortage. Appropriate candidate selection is crucial for successful outcomes following cardiac transplantation. We, therefore, analyzed preoperative factors of patients undergoing HTx in order to define clinical factors that would allow risk stratification of patients evaluated for HTx.
Methods: We retrospectively analyzed 769 patients undergoing HTx at Columbia University Medical Center between 1999 and 2010. Preoperative laboratory values at the time of HTx, medical history, donor characteristics, perioperative clinical events and postoperative outcome were collected from electronic medical records. Survival was confirmed using the social security death index and clinical follow-up at our center. Univariate and multivariate proportional hazard ratios were calculated for 61 individual characteristics to identify factors associated with short and long-term survival after HTx. Significant factors were summarized in a prognostic scoring system for the prediction of survival after HTx. The predictive power of this system was validated in the United Network of Organ Sharing (UNOS) dataset (n=29,734).
Results: Our analysis identified liver dysfunction (albumin<3.5 mg/dL or total bilirubin>1.3 mg/dL) and renal dysfunction (GFR<40 ml/min), re-HTx, prior stroke or cancer, amyloid, diabetes mellitus, age>65 yrs and more than 2 prior thoracic surgeries with sternotomy as factors associated with poor survival following HTx. The prognostic risk score derived from these factors effectively stratified high risk (4+ points) versus low risk (0-3 points) patients in regard to survival following HTx (86.2% vs. 77.8% at 1-yr and 74.3% vs. 55.9% at 5-yrs post-HTx; p<0.001). These findings were validated and confirmed in the UNOS dataset (88.2% vs. 83.5% at 1-yr and 74.2% vs. 67.2% at 5-yrs post-HTx; p<0.0001).
Conclusion: Survival of patients following HTx may be improved by use of this noninvasive risk-stratification model for the selection of transplant candidates.
- © 2011 by American Heart Association, Inc.