Creation of a Quantitative Recipient Risk Index for Mortality Prediction After Cardiac Transplantation (IMPACT)

Weiss, Eric S.; Allen, Jeremiah G.; Arnaoutakis, George J.; George, Timothy J.; Russell, Stuart D.; Shah, Ashish S.; Conte, John V.

doi:10.1016/j.athoracsur.2011.04.030

Cited by 208 publications

(184 citation statements)

References 18 publications

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“…The expected mortality based on recipient risk was then calculated by inputting the average IMPACT score of recipients at a center into the following equation, which was previously derived: estimated 1-year mortality = [e^(0.13 × IMPACT) -2.75]/ {1 + [e^(0.13 × IMPACT) -2.75]}. 6 The expected mortality based on donor risk was calculating by inputting the average donor risk score of donors at a center into the following equation, which was generated from the predictive model in the original UNOS cohort: estimated 1-year mortality = 10.024 × [e^(0.0847 × donor risk score)]. 8 Because these risk indexes have similar predictive power in estimating 1-year mortality after OHT, the expected mortalities at the center level were calculated by averaging the estimated 1-year mortalities based on the mean recipient and donor risk scores for the patients at that center.…”

Section: Discussionmentioning

confidence: 99%

“…For recipient risk, the Index for Mortality Prediction After Cardiac Transplantation, or IMPACT score, was used (Appendix I in the online-only Data Supplement). 6 The IMPACT score is a 50-point scoring system that incorporates 12 recipient-specific risk factors. It has been validated as a highly predictive risk score for estimating 1-year mortality after OHT.…”

Section: Discussionmentioning

confidence: 99%

“…A UNOS study of more than 21 000 OHT patients transplanted between 1999 and 2008 found that blacks, but not other races, were at increased risk of 1-year mortality as compared with whites after risk adjustment. 6 Another UNOS analysis demonstrated that blacks had an 11.4% absolute decrease in 10-year survival compared with whites and a 46% increased risk of cumulative mortality after risk adjustment. 5 A study spanning 22 years and more than 39 000 patients found that, although mortality decreased over time for all races, the disparity in mortality between blacks and whites remained unchanged.…”

Section: Recipient Race and Mortality After Ohtmentioning

confidence: 99%

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Racial Disparities in Outcomes of Adult Heart Transplantation

et al. 2015

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Background— This study evaluated whether minority orthotopic heart transplant (OHT) recipients tend to be transplanted at worse performing centers. Methods and Results— OHT recipients between 2000 and 2010 were identified in the United Network for Organ Sharing database and stratified by race. Center performance was evaluated using observed-to-expected mortality ratios that were calculated using validated indexes for recipient and donor risk in OHT. The primary outcome was 1-year post-OHT mortality. A total of 102 centers performed OHT in 18 085 patients. Blacks had higher unadjusted 1-year mortality, which was confirmed after risk adjustment. Blacks had increased risk-adjusted mortality at poor performing centers (observed-to-expected mortality ratio, >1.2; odds ratio, 1.37 [95% confidence interval, 1.12–1.69]; P =0.002) and a strong trend toward increased mortality at excellent performing centers (observed-to-expected mortality ratio, <0.8; odds ratio, 1.42 [95% confidence interval, 0.99–2.02]; P =0.06). A higher proportion of blacks were treated at centers with higher-than-expected mortality (56.4% versus 47.1% whites versus 48.1% Hispanics; P <0.001), a finding that persisted after adjusting for insurance type and highest education level. In addition, there was a positive correlation between the percentage of blacks and observed-to-expected mortality ratios at the center level ( r =0.32; P =0.001). In multivariable analysis incorporating immunologic and socioeconomic variables, there was no clear dominant source for the disparities in outcomes of OHT between races. Conclusions— Blacks have a propensity to be transplanted at worse performing centers; however, center effect alone does not explain the mortality difference between ethnicities. Although referral of minorities to better performing centers would improve absolute survival, it would not likely eliminate the racial disparities that exist in OHT outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Recipient Race and Mortality After Ohtmentioning

confidence: 99%

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Racial Disparities in Outcomes of Adult Heart Transplantation

et al. 2015

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“…[3] To this end, several researchers have utilized registry data to create and validate OHT recipient risk scores. [14,15] Although these useful scores have the strength of being based on a large number of OHT, they are limited to the variables collected in these registries. While the United Network for Organ Sharing database collects information on prior cardiac surgery, it does not indicate the number of prior sternotomies.…”

Section: Reoperative Sternotomymentioning

confidence: 99%

“…Additionally, most current OHT risk scores do not incorporate reoperative sternotomy because these data are not adequately captured by existing registries. [14,15] Therefore, we undertook this multi-institutional study to characterize the incidence and impact of reoperative sternotomy on outcomes after OHT.…”

Section: Introductionmentioning

confidence: 99%

442 Reoperative Sternotomy Is Associated with Increased Mortality after Heart Transplantation

George

Beaty

Ewald

et al. 2012

The Journal of Heart and Lung Transplantation

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Evolving Trends in Adult Heart Transplant With the 2018 Heart Allocation Policy Change

et al. 2021

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IMPORTANCEThe US heart allocation policy was changed on October 18, 2018. The association of this change with recipient and donor selection and outcomes remains to be elucidated.OBJECTIVE To evaluate changes in patient characteristics, wait list outcomes, and posttransplant outcomes after the recent allocation policy change in heart transplant. DESIGN, SETTING, AND PARTICIPANTSIn this cohort study, all 15 631 adults undergoing heart transplants, excluding multiorgan transplants, in the US as identified by the United Network for Organ Sharing multicenter, national registry were reviewed. Patients were stratified according to prepolicy change (October 1, 2015, to October 1, 2018) and postpolicy change (October 18, 2018 or after). Follow-up data were available through March 31, 2020.EXPOSURES Heart transplants after the policy change. MAIN OUTCOMES AND MEASURESCompeting risk regression for wait list outcomes was performed. Posttransplant survival was compared using the Kaplan-Meier method, and risk adjustment was performed using multivariable Cox proportional hazards regression analysis. RESULTSIn this cohort study, of the 15 631 patients undergoing transplant, 10 671 (mean [SD] age, 53.1 [12.7] years; 7823 [73.3%] male) were wait listed before and 4960 (mean [SD] age, 52.7 [13.0] years; 3610 [72.8%] male) were wait listed after the policy change. Competing risk regression demonstrated reduced likelihood of mortality or deterioration (subhazard ratio [SHR], 0.60; 95% CI, 0.52-0.69; P < .001), increased likelihood of transplant (SHR, 1.38; 95% CI, 1.32-1.45; P < .001), and reduced likelihood of recovery (SHR, 0.54; 95% CI, 0.40-0.73; P < .001) for wait listed patients after the policy change. A total of 6078 patients underwent transplant before and 2801 after the policy change. Notable changes after the policy change included higher frequency of bridging with temporary mechanical circulatory support and lower frequency of bridging with durable left ventricular assist devices. Posttransplant survival was reduced after the policy change (1-year: 92.1% vs 87.5%; log-rank P < .001), a finding that persisted after risk adjustment (HR, 1.29; 95% CI, 1.07-1.55; P = .008).CONCLUSIONS AND RELEVANCE Substantial changes have occurred in adult heart transplant in the US after the policy change in October 2018. Wait list outcomes have improved, although posttransplant survival has decreased. These data confirm findings from earlier preliminary analyses and demonstrate that these trends have persisted to 1-year follow-up, underscoring the importance of continued reevaluation of the new heart allocation policy.

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Creation of a Quantitative Recipient Risk Index for Mortality Prediction After Cardiac Transplantation (IMPACT)

Cited by 208 publications

References 18 publications

Racial Disparities in Outcomes of Adult Heart Transplantation

Racial Disparities in Outcomes of Adult Heart Transplantation

442 Reoperative Sternotomy Is Associated with Increased Mortality after Heart Transplantation

Evolving Trends in Adult Heart Transplant With the 2018 Heart Allocation Policy Change

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