Variables of importance in the Scientific Registry of Transplant Recipients database predictive of heart transplant waitlist mortality

Transplantation of HEarts to MaxImize Survival (THEMIS) Investigators

Research output: Contribution to journalArticle

Abstract

The prelisting variables essential for creating an accurate heart transplant allocation score based on survival are unknown. To identify these we studied mortality of adults on the active heart transplant waiting list in the Scientific Registry of Transplant Recipients database from January 1, 2004 to August 31, 2015. There were 33 069 candidates awaiting heart transplantation: 7681 UNOS Status 1A, 13 027 Status 1B, and 12 361 Status 2. During a median waitlist follow-up of 4.3 months, 5514 candidates died. Variables of importance for waitlist mortality were identified by machine learning using Random Survival Forests. Strong correlates predicting survival were estimated glomerular filtration rate (eGFR), serum albumin, extracorporeal membrane oxygenation, ventricular assist device, mechanical ventilation, peak oxygen capacity, hemodynamics, inotrope support, and type of heart disease with less predictive variables including antiarrhythmic agents, history of stroke, vascular disease, prior malignancy, and prior tobacco use. Complex interactions were identified such as an additive risk in mortality based on renal function and serum albumin, and sex-differences in mortality when eGFR >40 mL/min/1.73 m. Most predictive variables for waitlist mortality are in the current tiered allocation system except for eGFR and serum albumin which have an additive risk and complex interactions.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StatePublished - Jan 1 2019

Fingerprint

Registries
Databases
Transplants
Glomerular Filtration Rate
Mortality
Serum Albumin
Survival
Extracorporeal Membrane Oxygenation
Heart-Assist Devices
Waiting Lists
Tobacco Use
Heart Transplantation
Vascular Diseases
Artificial Respiration
Sex Characteristics
Heart Diseases
Hemodynamics
Stroke
Transplant Recipients
Oxygen

Keywords

  • artificial organs/support devices: heart/ventricular assist devices
  • clinical research/practice
  • gender
  • health services and outcomes research
  • heart transplantation/cardiology
  • organ procurement and allocation
  • organ transplantation in general
  • patient survival
  • Scientific Registry for Transplant Recipients (SRTR)
  • waitlist management

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Variables of importance in the Scientific Registry of Transplant Recipients database predictive of heart transplant waitlist mortality. / Transplantation of HEarts to MaxImize Survival (THEMIS) Investigators.

In: American Journal of Transplantation, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "The prelisting variables essential for creating an accurate heart transplant allocation score based on survival are unknown. To identify these we studied mortality of adults on the active heart transplant waiting list in the Scientific Registry of Transplant Recipients database from January 1, 2004 to August 31, 2015. There were 33 069 candidates awaiting heart transplantation: 7681 UNOS Status 1A, 13 027 Status 1B, and 12 361 Status 2. During a median waitlist follow-up of 4.3 months, 5514 candidates died. Variables of importance for waitlist mortality were identified by machine learning using Random Survival Forests. Strong correlates predicting survival were estimated glomerular filtration rate (eGFR), serum albumin, extracorporeal membrane oxygenation, ventricular assist device, mechanical ventilation, peak oxygen capacity, hemodynamics, inotrope support, and type of heart disease with less predictive variables including antiarrhythmic agents, history of stroke, vascular disease, prior malignancy, and prior tobacco use. Complex interactions were identified such as an additive risk in mortality based on renal function and serum albumin, and sex-differences in mortality when eGFR >40 mL/min/1.73 m. Most predictive variables for waitlist mortality are in the current tiered allocation system except for eGFR and serum albumin which have an additive risk and complex interactions.",
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