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Lescroart M, Kransdorf EP, Scuppa MF, Patel JK, Coutance G. Importance of Transplant Era on Post-Heart Transplant Predictive Models: A UNOS Cohort Analysis. Clin Transplant 2024; 38:e15403. [PMID: 39023089 DOI: 10.1111/ctr.15403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/14/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND The application of posttransplant predictive models is limited by their poor statistical performance. Neglecting the dynamic evolution of demographics and medical practice over time may be a key issue. OBJECTIVES Our objective was to develop and validate era-specific predictive models to assess whether these models could improve risk stratification compared to non-era-specific models. METHODS We analyzed the United Network for Organ Sharing (UNOS) database including first noncombined heart transplantations (2001-2018, divided into four transplant eras: 2001-2005, 2006-2010, 2011-2015, 2016-2018). The endpoint was death or retransplantation during the 1st-year posttransplant. We analyzed the dynamic evolution of major predictive variables over time and developed era-specific models using logistic regression. We then performed a multiparametric evaluation of the statistical performance of era-specific models and compared them to non-era-specific models in 1000 bootstrap samples (derivation set, 2/3; test set, 1/3). RESULTS A total of 34 738 patients were included, 3670 patients (10.5%) met the composite endpoint. We found a significant impact of transplant era on baseline characteristics of donors and recipients, medical practice, and posttransplant predictive models, including significant interaction between transplant year and major predictive variables (total serum bilirubin, recipient age, recipient diabetes, previous cardiac surgery). Although the discrimination of all models remained low, era-specific models significantly outperformed the statistical performance of non-era-specific models in most samples, particularly concerning discrimination and calibration. CONCLUSIONS Era-specific models achieved better statistical performance than non-era-specific models. A regular update of predictive models may be considered if they were to be applied for clinical decision-making and allograft allocation.
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Affiliation(s)
- Mickaël Lescroart
- Department of Cardiac Surgery, Institute of Cardiology, La Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne Université-Medical School, Paris, France
| | - Evan P Kransdorf
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Jignesh K Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Guillaume Coutance
- Department of Cardiac Surgery, Institute of Cardiology, La Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne Université-Medical School, Paris, France
- INSERM UMR 970, Paris Translational Research Centre for Organ Transplantation, Université de Paris, Paris, France
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Gelzinis TA, Ungerman E, Jayaraman AL, Bartels S, Bond JA, Hayanga HK, Patel B, Khoche S, Subramanian H, Ball R, Knight J, Choi C, Ellis S. The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2021 Part II: Cardiac Transplantation. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00339-7. [PMID: 37353423 DOI: 10.1053/j.jvca.2023.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 06/25/2023]
Abstract
This article spotlights the research highlights of this year that specifically pertain to the specialty of anesthesia for heart transplantation. This includes the research on recent developments in the selection and optimization of donors and recipients, including the use of donation after cardiorespiratory death and extended criteria donors, the use of mechanical circulatory support and nonmechanical circulatory support as bridges to transplantation, the effect of COVID-19 on heart transplantation candidates and recipients, and new advances in the perioperative management of these patients, including the use of echocardiography and postoperative outcomes, focusing on renal and cerebral outcomes.
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Affiliation(s)
| | - Elizabeth Ungerman
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Arun L Jayaraman
- Department of Anesthesiology and Perioperative Medicine, Department of Critical Care Medicine, Mayo Clinic, Pheonix, AZ
| | - Steven Bartels
- Department of Anesthesiology and Perioperative Medicine, Loyola University Medical Center, Maywood, IL
| | - Jonathan A Bond
- Division of Adult Cardiothoracic Anesthesiology, University of Kentucky, Lexington, KY
| | - Heather K Hayanga
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, WV
| | - Bhoumesh Patel
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - Swapnil Khoche
- Department of Anesthesiology, University of California, San Diego, CA
| | - Harikesh Subramanian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Ryan Ball
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Joshua Knight
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Christine Choi
- Department of Anesthesiology, University of California, San Diego, CA
| | - Sarah Ellis
- Department of Anesthesiology, University of California, San Diego, CA
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Impact of the 2018 French two-score allocation scheme on the profile of heart transplantation candidates and recipients: Insights from a high-volume centre. Arch Cardiovasc Dis 2023; 116:54-61. [PMID: 36624026 DOI: 10.1016/j.acvd.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND In 2018, a new cardiac allograft allocation scheme, based on an individual scoring system, considering the risk of death both on the waiting list and after heart transplantation, was implemented in France. AIM To assess the impact of this new scheme on the profile of transplantation candidates and recipients. METHODS In this single-centre retrospective study, we included consecutive patients listed and/or transplanted between 01 January 2012 and 30 September 2021 at La Pitié-Salpêtrière Hospital. Baseline characteristics of patients were retrieved from the national CRISTAL registry and were compared according to the type of allocation scheme (before or after 2018). RESULTS A total of 1098 newly listed transplantation candidates and 855 transplant recipients were included. One-year mortality rates after listing and after transplantation were 12.4% and 20%, respectively. At listing, the proportion of candidates on inotropes significantly declined following the scheme update (26.3 versus 20.9%; P=0.038), reflecting a change in medical practice. At transplantation, recipients had worse kidney function (estimated glomerular filtration rate<60mL/min/1.73 m2: old scheme, 29.7%; new scheme, 46.4%; P<0.001) and were more likely to be on extracorporeal membrane oxygenation support (33.5% versus 28.1%; P=0.080) under the new scheme, reflecting the prioritization of more severe patients. Outcomes after transplantation were not significantly influenced by the allocation system. CONCLUSIONS The implementation of the 2018 French allocation scheme had a limited impact on the profile of transplantation candidates, but selected more severe patients for transplantation without significant impact on outcomes after transplantation.
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Rieth AJ, Rivinius R, Lühring T, Grün D, Keller T, Grinninger C, Schüttler D, Bara CL, Helmschrott M, Frey N, Sandhaus T, Schulze C, Kriechbaum S, Vietheer J, Sindermann J, Welp H, Lichtenberg A, Choi YH, Richter M, Tello K, Richter MJ, Hamm CW, Boeken U. Hemodynamic markers of pulmonary vasculopathy for prediction of early right heart failure and mortality after heart transplantation. J Heart Lung Transplant 2022; 42:512-521. [PMID: 36333208 DOI: 10.1016/j.healun.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/13/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Elevated pulmonary vascular resistance (PVR) is broadly accepted as an imminent risk factor for mortality after heart transplantation (HTx). However, no current HTx recipient risk score includes PVR or other hemodynamic parameters. This study examined the utility of various hemodynamic parameters for risk stratification in a contemporary HTx population. METHODS Patients from seven German HTx centers undergoing HTx between 2011 and 2015 were included retrospectively. Established risk factors and complete hemodynamic datasets before HTx were analyzed. Outcome measures were overall all-cause mortality, 12-month mortality, and right heart failure (RHF) after HTx. RESULTS The final analysis included 333 patients (28% female) with a median age of 54 (IQR 46-60) years. The median mean pulmonary artery pressure was 30 (IQR 23-38) mm Hg, transpulmonary gradient 8 (IQR 5-10) mm Hg, and PVR 2.1 (IQR 1.5-2.9) Wood units. Overall mortality was 35.7%, 12-month mortality was 23.7%, and the incidence of early RHF was 22.8%, which was significantly associated with overall mortality (log-rank HR 4.11, 95% CI 2.47-6.84; log-rank p < .0001). Pulmonary arterial elastance (Ea) was associated with overall mortality (HR 1.74, 95% CI 1.25-2.30; p < .001) independent of other non-hemodynamic risk factors. Ea values below a calculated cutoff represented a significantly reduced mortality risk (HR 0.38, 95% CI 0.19-0.76; p < .0001). PVR with the established cutoff of 3.0 WU was not significant. Ea was also significantly associated with 12-month mortality and RHF. CONCLUSIONS Ea showed a strong impact on post-transplant mortality and RHF and should become part of the routine hemodynamic evaluation in HTx candidates.
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Affiliation(s)
- Andreas J Rieth
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany, German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany.
| | - Rasmus Rivinius
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany, German Center for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Tom Lühring
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany, German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany
| | - Dimitri Grün
- Department of Cardiology, Justus Liebig University Giessen, Giessen, Germany
| | - Till Keller
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany, German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany; Department of Cardiology, Justus Liebig University Giessen, Giessen, Germany
| | - Carola Grinninger
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Dominik Schüttler
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Christoph L Bara
- Department of Cardiac, Thorax, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Matthias Helmschrott
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany, German Center for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Norbert Frey
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany, German Center for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Tim Sandhaus
- Department of Cardiac Surgery, University Hospital Jena, Jena, Germany
| | | | - Steffen Kriechbaum
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany, German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany
| | - Julia Vietheer
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany, German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany
| | - Jürgen Sindermann
- Department of Cardiology, Münster University Hospital, Münster, Germany; Department of Rehabilitation, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Henryk Welp
- Department of Cardiac Surgery, Münster University Hospital, Münster, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Manfred Richter
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Khodr Tello
- Department of Internal Medicine, Justus Liebig University Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Manuel J Richter
- Department of Internal Medicine, Justus Liebig University Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany; Department of Pneumology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany, German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany; Department of Cardiology, Justus Liebig University Giessen, Giessen, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Düsseldorf University Hospital, Düsseldorf, Germany
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