Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany.
ESC Heart Fail. 2021 Dec;8(6):4843-4851. doi: 10.1002/ehf2.13673. Epub 2021 Oct 26.
Some risk assessment tools have been developed to categorize mortality risk in heart transplant recipients, but it is unclear whether these tools can be used interchangeable in different transplant regions.
We performed a retrospective single-centre study in 1049 adult German heart transplant recipients under jurisdiction of Eurotransplant. Univariable and multivariable Cox regression analysis was used to generate a risk scoring system. C-statistics were used to compare our score with a US score and a French score regarding their ability to discriminate between 1 year survivors and non-survivors within our study cohort. Of 38 parameters assessed, seven recipient-specific parameters [age, height, dilated cardiomyopathy (DCM), ischaemic cardiomyopathy (ICM), total bilirubin, extracorporeal membrane oxygenation (ECMO), and biventricular assist device/total artificial heart (BVAD/TAH) implant], one donor-specific parameter (cold ischaemic time), and one recipient-independent and donor-independent other parameter (late transplant era) were statistically significant in predicting 1 year mortality. The initial score was generated by using the regression coefficients from the multivariable analysis as follows: 1.70 * ln age - 4.0 * ln height - 0.9 * diagnosis (= 1 if diagnosis = DCM) - 0.67 * diagnosis (= 1 if diagnosis = ICM) + 0.33 * ln total bilirubin + 1.74 * ln cold ischaemic time + 0.98 * mechanical circulatory support (MCS) implant (= 1 if MCS implant = ECMO) + 0.47 * MCS implant (= 1 of MCS implant = BVAD/TAH) - 0.66 * transplant era (= 1 if transplant era = 2017-2018). The initial score was converted into the Bad Oeynhausen (BO) score as a positive integer variable by means of the following formula: BO score = (initial score + 8) * 3. In patients scoring 2 to <7 points (n = 112), 7 to <11 points (n = 580), 11 to <15 points (n = 339), and 15 to 20 points (n = 18), 1 year survival was 93.1%, 84.2%, 66.9%, and 27.8%, respectively. The c-index of our score was 0.73 [95% confidence interval (CI): 0.69-0.77]. Values were in our cohort for the US and French scores 0.66 (95% CI: 0.62-0.70) and 0.63 (95% CI: 0.59-0.67), respectively.
Data indicate that our score, but also risk assessment tools from other transplant regions, may be used as a reliable support for risk-adjusted organ allocation and potentially help to improve outcomes in heart transplantation. Further developments will have to include as yet unaccounted risk factors for even more reliable predictions.
已经开发了一些风险评估工具来对心脏移植受者的死亡率进行分类，但尚不清楚这些工具是否可以在不同的移植区域互换使用。
我们对德国心脏移植受者（归属于欧洲移植组织）的 1049 名成年人进行了回顾性单中心研究。使用单变量和多变量 Cox 回归分析生成风险评分系统。C 统计量用于比较我们的评分与美国评分和法国评分在本研究队列中对 1 年幸存者和非幸存者进行区分的能力。在评估的 38 个参数中，7 个受者特异性参数[年龄、身高、扩张型心肌病（DCM）、缺血性心肌病（ICM）、总胆红素、体外膜氧合（ECMO）和双心室辅助装置/全人工心脏（BVAD/TAH）植入]、1 个供者特异性参数（冷缺血时间）和 1 个受者独立和供者独立的其他参数（晚期移植时代）在预测 1 年死亡率方面具有统计学意义。初始评分通过使用多变量分析中的回归系数生成，如下所示：1.70 * ln 年龄-4.0 * ln 身高-0.9 * 诊断（= 1 如果诊断= DCM）-0.67 * 诊断（= 1 如果诊断= ICM）+0.33 * ln 总胆红素+1.74 * ln 冷缺血时间+0.98 * 机械循环支持（MCS）植入（= 1 如果 MCS 植入= ECMO）+0.47 * MCS 植入（= 1 为 MCS 植入= BVAD/TAH）-0.66 * 移植时代（= 1 如果移植时代= 2017-2018）。初始评分通过以下公式转换为博霍尔特（BO）评分作为正整数变量：BO 评分=（初始评分+8）* 3。在评分 2 至<7 分（n=112）、7 至<11 分（n=580）、11 至<15 分（n=339）和 15 至 20 分（n=18）的患者中，1 年生存率分别为 93.1%、84.2%、66.9%和 27.8%。我们的评分的 C 指数为 0.73[95%置信区间（CI）：0.69-0.77]。我们的评分在我们的队列中的值为美国和法国评分的 0.66（95%CI：0.62-0.70）和 0.63（95%CI：0.59-0.67）。
数据表明，我们的评分以及来自其他移植区域的风险评估工具可能被用作风险调整器官分配的可靠支持，并有可能有助于改善心脏移植的结果。进一步的发展将必须包括迄今为止尚未考虑的风险因素，以进行更可靠的预测。
