Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria.
Transpl Int. 2021 Mar;34(3):546-560. doi: 10.1111/tri.13822. Epub 2021 Feb 22.
The Heart Donor Score (HDS) predicts donor organ discard for medical reasons and survival after heart transplantation (HTX) in the Eurotransplant allocation system. Our aim was to adapt the HDS for application in the United Network for Organ Sharing (UNOS) registry. To adjust for differences between the Eurotransplant and UNOS registries, the "adapted HDS" was created (aHDS) by exclusion of the covariates "valve function," "left-ventricular hypertrophy," and exclusion of "drug abuse" from the variable "compromised history." Two datasets were analyzed to evaluate associations of the aHDS with donor organ discard (n = 70 948) and survival (n = 19 279). The aHDS was significantly associated with donor organ discard [odds ratio 2.72, 95% confidence interval (CI) 2.68-2.76, P < 0.001; c-statistic: 0.937). The score performed comparably in donors <60 and ≥60 years of age. The aHDS was a significant predictor of survival as evaluated by univariate Cox proportional hazards analysis (hazard ratio 1.04, 95% CI 1.01-1.07, P = 0.023), although the association lost significance in a multivariable model. The aHDS predicts donor organ discard. Negative effects of most aHDS components on survival are likely eliminated by highly accurate donor selection processes.
心脏供体评分（HDS）可预测因医疗原因而丢弃供体器官以及心脏移植（HTX）后的存活率，该评分在欧洲器官移植分配系统中使用。我们的目的是调整 HDS 以适用于美国器官共享网络（UNOS）登记处。为了调整欧洲移植登记处和 UNOS 登记处之间的差异，排除了协变量“瓣膜功能”、“左心室肥厚”，并从变量“受损史”中排除了“药物滥用”，从而创建了（aHDS）。分析了两个数据集，以评估 aHDS 与供体器官丢弃（n=70948）和存活（n=19279）的相关性。aHDS 与供体器官丢弃显著相关[比值比 2.72，95%置信区间（CI）2.68-2.76，P<0.001；c 统计量：0.937]。该评分在<60 岁和≥60 岁的供体中表现相当。aHDS 在单变量 Cox 比例风险分析中是存活的显著预测因子（风险比 1.04，95%CI 1.01-1.07，P=0.023），尽管在多变量模型中该相关性失去了意义。aHDS 可预测供体器官丢弃。aHDS 各成分对存活的负面影响可能因高度准确的供体选择过程而消除。
