A simple approach to risk stratification in adult heart transplantation

Abstract

Objective: While there are numerous reports in the literature of risk factors for graft failure after heart transplantation, simple models for risk stratification are lacking. This study describes a simple method for risk stratification in adult heart transplantation that can be applied when the size of a dataset is insufficient for formal regression modelling. Methods: Multi-centre prospective cohort study. Fourteen risk factors documented in the literature as increasing post transplant graft failure were used to formulate a model. Risk factors included in the model were recipient age >50 years, pre-operative ventilatory support, pre-operative circulatory support, >1 previous sternotomy, pulmonary vascular resistance >2.5 wood units, male with body surface area >2.5 m², retransplant, ischaemic time >3.5 h, donor age >45 years, donor inotropic support >10 μg/kg per min dopamine, female donor, ratio donor/recipient body surface area Results: Twenty eight transplants were low risk, 82 moderate, 201 high and 62 very high. The 30-day survival (70% CI) for the risk groups was low, 97% (93–100), moderate 95% (92–98), high 87% (84–89) and very high 80% (75–83) (P=0.02). Conclusions: This preliminary model enables some stratification of heart transplant procedures according to donor and recipient risk profile. Further work will be directed at refining and validating the model.