Donor and recipient risk assessment and its influence on clinical outcome in heart transplantation at a reference center in Brazil

Abstract

Background: Heart transplantation is the gold standard treatment for end-stage heart failure patients. However, the shortage of donor hearts limits its applicability. This study aims to evaluate the risk factors associated with survival within 1-year after heart transplantation. Methods: A single-center retrospective cohort study evaluated 299 adult patients who underwent transplantation at the Heart Institute (Incor) between January 2013 and December 2019. Univariate and multivariate Cox regression analyses were conducted to identify independent predictors of 1-year survival among well-established prognostic clinical characteristics described in the literature. Patients were followed until death or the last observation on October 12, 2022. A Simple Risk Index was created based on the hazard ratio of each factor. Results: Chagas disease was the most common cause of cardiomyopathy (36%). Most patients were male (65%) with a median age of 50 (39-58) years. Four variables observed during the last clinical assessment in the intensive care unit before surgery were found to be statistically significant: maximum Sequential Organ Failure Assessment (SOFA) score, creatinine clearance in 3 quartile categories, C-reactive protein in 3 categories, and white blood cell count in 3 categories. The model demonstrated good discrimination (C-index = 0.74) and calibration. The group at high risk (>20 points) exhibited significantly higher mortality rates at 1 year (p < 0.001). Conclusions: The study introduces a risk prediction score for 1-year post-transplant mortality in a reference center in Brazil. The score is based on four variables: maximum SOFA score, creatinine clearance, C-reactive protein, and white blood cell count.

Keywords

• heart transplantation
• prognosis
• heart failure, systolic
• shock, cardiogenic
• cardiomyopathies