Predictive value of liver damage for severe early complications and survival after heart transplantation: A retrospective analysis

Lebray, Pascal; Varnous, Shaïda; Pascale, Alina; Léger, Philippe; Luyt, Charles Edouard; Ratziu, Vlad; Munteanu, Mona; Amar, Salima Ould; Thabut, Dominique; Chastre, Jean; Pavie, Alain; Poynard, Thierry; Leprince, Pascal

doi:10.1016/j.clinre.2018.03.006

Cited by 14 publications

(13 citation statements)

References 19 publications

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“…Of the 71 articles, 21 studies were included in the systematic review (Figure ). There were 16 scores identified: five were not validated, four were internally validated, and seven were validated in external cohorts . Table describes scores validated in external cohorts and Table describes scores that were not validated or only internally validated.…”

Section: Resultsmentioning

confidence: 99%

“…A very low‐risk recipient would have a 94% and 89% 1‐year survival with a low‐ and high‐risk donor respectively, whereas a very high‐risk recipient would have an 80% and 62% 1‐year survival with a low‐ and high‐risk donor respectively. Lastly, the model for end‐stage liver disease (MELD) Ascites (MA) score included 2 recipient predictors: MELD score and presence of ascites on clinical examination . It was derived from 200 high‐risk recipients at one center and reported modest discrimination with a wide confidence interval for 90‐day survival (AUROC 0.73 [0.55‐0.82]).…”

Section: Resultsmentioning

confidence: 99%

“…There were 16 scores identified: five were not validated, [19][20][21][22] four were internally validated, [23][24][25][26] and seven were validated in external cohorts. [17][18][19][21][22][23][24][25][26][27][28][29] Table 1 describes scores validated in external cohorts and Table 2 describes scores that were not validated or only internally validated. There were 28 donor and 48 recipient variables identified in the 16 scores ( Figure 2).…”

Section: Re Sultsmentioning

confidence: 99%

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Risk prediction models for survival after heart transplantation: A systematic review

Aleksova

Alba

Molinero

et al. 2020

American Journal of Transplantation

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Risk prediction scores have been developed to predict survival following heart transplantation (HT). Our objective was to systematically review the model characteristics and performance for all available scores that predict survival after HT. Ovid Medline and Epub Ahead of Print and In‐Process & Other Non‐Indexed Citations, Ovid Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Clinical Trials were searched to December 2018. Eligible articles reported a score to predict mortality following HT. Of the 5392 studies screened, 21 studies were included that derived and/or validated 16 scores. Seven (44%) scores were validated in external cohorts and 8 (50%) assessed model performance. Overall model discrimination ranged from poor to moderate (C‐statistic/area under the receiver operating characteristics 0.54‐0.77). The IMPACT score was the most widely validated, was well calibrated in two large registries, and was best at discriminating 3‐month survival (C‐statistic 0.76). Most scores did not perform particularly well in any cohort in which they were assessed. This review shows that there are insufficient data to recommend the use of one model over the others for prediction of post‐HT outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

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Risk prediction models for survival after heart transplantation: A systematic review

Aleksova

Alba

Molinero

et al. 2020

American Journal of Transplantation

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“…Interestingly, bridging fibrosis was not significantly associated with post-operative liver failure or survival probably due to a high rate of heterogenous fibrosis within the liver for these patients (13,63). The presence of ascites and renal dysfunction at listing were also independently associated with primary graft dysfunctions and post-operative 90-day mortality rate (77).…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 87%

From congestive hepatopathy to hepatocellular carcinoma, how can we improve patient management?

et al. 2021

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Summary Heart failure and liver disease often coexist because of systemic disorders and diseases that affect both organs as well as complex cardio-hepatic interactions. Heart failure can cause acute or chronic liver injury due to ischaemia and passive venous congestion, respectively. Congestive hepatopathy is frequently observed in patients with congenital heart disease and after the Fontan procedure, but also in older patients with chronic heart failure. As congestive hepatopathy can evolve into cirrhosis and hepatocellular carcinoma, screening for liver injury should be performed in patients with chronic cardiac diseases and after Fontan surgery. Fibrosis starts in the centro-lobular zone and will extend progressively to the portal area. Chronic liver injury can be reversible if heart function improves. However, in the case of terminal heart failure, uncontrolled by medical resources or by assistive device support, the combination of heart and liver transplants must be discussed in patients with chronic advanced liver fibrosis. In this review of the literature, we will focus on congestive hepatopathy and its complications, such as liver fibrosis and hepatocellular carcinoma, with the aim of improving the management and surveillance of patients experiencing these complications.

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“…A total of 19 different models were identified. Prognostic models were excluded from our study if the calculation of an individual score was not possible (tree of predictors) 12 or if 2 or more predictive variables were not available in the UNOS dataset 13,14 . A total of 16 relevant scores were included in our study.…”

Section: Methodsmentioning

confidence: 99%

Statistical performance of 16 posttransplant risk scores in a contemporary cohort of heart transplant recipients

Coutance

Kransdorf

Bonnet

et al. 2021

American Journal of Transplantation

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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.

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Predictive value of liver damage for severe early complications and survival after heart transplantation: A retrospective analysis

Cited by 14 publications

References 19 publications

Risk prediction models for survival after heart transplantation: A systematic review

Risk prediction models for survival after heart transplantation: A systematic review

From congestive hepatopathy to hepatocellular carcinoma, how can we improve patient management?

Statistical performance of 16 posttransplant risk scores in a contemporary cohort of heart transplant recipients

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