Statistical performance of 16 posttransplant risk scores in a contemporary cohort of heart transplant recipients.
United Network for Organ Sharing (UNOS)
clinical decision-making
clinical research/practice
heart failure/injury
heart transplantation/cardiology
organ allocation
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
26
05
2020
revised:
06
07
2020
accepted:
19
07
2020
pubmed:
28
7
2020
medline:
22
6
2021
entrez:
27
7
2020
Statut:
ppublish
Résumé
Accurate risk stratification of early heart transplant failure is required to avoid futile transplants and rationalize donor selection. We aimed to evaluate the statistical performance of existing risk scores on a contemporary cohort of heart transplant recipients. After an exhaustive search, we identified 16 relevant risk scores. From the UNOS database, we selected all first noncombined adult heart transplants performed between 2014 and 2017 for validation. The primary endpoint was death or retransplant during the first year posttransplant. For all scores, we analyzed their association with outcomes, sensitivity, specificity, likelihood ratios, and discrimination (concordance index and overlap of individual scores). The cohort included 9396 patients. All scores were significantly associated with the primary outcome (P < .001 for all scores). Their likelihood ratios, both negative and positive, were poor. The discriminative performance of all scores was limited, with concordance index ranging from 0.544 to 0.646 (median 0.594) and an important overlap of individual scores between patients with or without the primary endpoint. Subgroup analyses revealed important variation in discrimination according to donor age, recipient age, and the type of assist device used at transplant. Our findings raise concerns about the use of currently available scores in the clinical field.
Identifiants
pubmed: 32713121
doi: 10.1111/ajt.16217
pii: S1600-6135(22)08389-7
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
645-656Informations de copyright
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.
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