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Heart Transplantation: An In-Depth Survival Analysis

Organization: Elsevier Inc
Journey Stage: (K) Early Survival After Transplant
Organization Type: Society or Professional Organization
Use Case(s): Allocation, Patient Experience
Country: USA

Pulled from PubMed

Eileen M Hsich 1, Eugene H Blackstone 2, Lucy W Thuita 3, Dennis M McNamara 4, Joseph G Rogers 5, Clyde W Yancy 6, Lee R Goldberg 7, Maryam Valapour 8, Gang Xu 9, Hemant Ishwaran 10

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.

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Key Contact:

Eileen M
Hsich •
Medical Director for the Heart Transplant Program, Professor of Medicine at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and a staff physician in the Section of Heart Failure and Transplantation Medicine of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute

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