Allograft discard risk index for heart transplantation
The numberof patients awaiting heart transplantation (HTx) substantially exceeds the number of donor hearts transplanted each year, yet nearly 65% of eligible donor hearts are discarded rather than transplanted.
METHODS:Deceased organ donors listed within the UNOS Deceased Donor Database between 2010 and 2020 were reviewed. Those greater than 10 years old and consented for heart donation were included and randomly separated into training (n = 48 435) and validation (n = 24 217) cohorts. A discard risk index (DSRI) was created using the results of univariable and multivariable analyses. Discard data were assessed at DSRI value deciles, and stratum-specific likelihood ratio (SSLR) analysis and Kaplan-Meier survival function were used for mortality data.
RESULTS:Factors associated with higher DSRI values included donor age > 45, LVEF, HBV-core antibodies, hypertension, and diabetes. The DSRI C-statistic was .906 in the training cohort and .904 in the validation cohort. The DSRI did not reliably predict 30-day or 1-year mortality after transplantation (C-statistic .539 and .532, respectively).
CONCLUSIONS:The factors leading to heart allograft discard are not correlated to the same degree with post-transplant outcomes. This suggests that optimizing utilization of certain allografts with slightly higher risk of discard could increase the heart donor pool with limited impact on posttransplant mortality.
CET Conclusion
| Reviewer: | Dr Liset Pengel, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford |
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| Conclusion: | The study developed a donor heart discard risk index (DSRI) using deceased donor data from UNOS. The DSRI aimed to predict the heart allograft discard using donor factors. The cohort of 72,652 donors was randomly split into a training and validation cohort. The two cohorts had similar demographics. A multivariable logistic regression analysis identified factors that were significantly associated with allograft discard, which included left ventricular ejection fraction, hepatitis B-virus core antibodies, diabetes and a donor age of >45y. The DSRI showed little correlation to mortality after transplantation. Data suggests that allografts with higher risk of discard could be used to increase donor heart utilisation without a significantly increased risk of mortality. |
Study Details
| Aims: | The primary aim of this study was to develop a discard risk index (DSRI) for predicting heart allograft discard using donor factors. |
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| Interventions: | The study cohort was randomly divided into a training cohort and a validation cohort. |
| Participants: | 72,652 heart donors. |
| Outcomes: | The main outcome of interest was to create a DSRI based on the results of univariate and multivariate analyses. |
| Follow Up: | N/A |
Metadata
| Funding: | Funding not described |
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| Publication type: | Randomised Controlled Trial |
| Organ: | Heart |
| Language: | English |
| Author email: | Ross.ReulJr@bcm.edu |
| MeSH terms: | Allografts; Child; Donor Selection; Graft Survival; Heart Transplantation; Humans; Risk Factors; Tissue Donors; Tissue and Organ Procurement; Transplantation, Homologous; Deceased; Donation After Brain Death (DBD); Donor Evaluation; Donors and Donation; Organ Acceptance; Risk Assessment |