Predictors of 1-year mortality in heart transplant recipients: a systematic review and meta-analysis

Foroutan, Farid; Alba, Ana Carolina; Guyatt, Gordon; Posada, Juan Duero; Hing, Nicholas Ng Fat; Arseneau, Erika; Meade, Maureen O.; Hanna, Steven; Badiwala, Mitesh; Ross, Heather J.

doi:10.1136/heartjnl-2017-311435

Cited by 65 publications

(38 citation statements)

References 75 publications

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“…19 The ISHLT registry has shown that long-term survival postheart transplant is significantly lower in diabetic patients compared to those without diabetes (12% reduction in survival by 10-year post-transplant). 26 Despite this, our model's effect estimates for impact of BMI are similar, but more precise, than previously published work. There was an absolute 2% and 7% increase risk of 1-year mortality in those age 40-65 and >65, respectively, compared to those with a normal BMI and an age of 40-65.…”

Section: Primary Findingssupporting

confidence: 56%

“…Hence, although we adjusted for the confounding and effect modifying impact of age and study source, we could not control for all other patient characteristics and comorbidities that may be modifying the risk of mortality. 26 Despite this, our model's effect estimates for impact of BMI are similar, but more precise, than previously published work. 2…”

Section: Limitationssupporting

confidence: 56%

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Impact of pretransplant recipient body mass index on post heart transplant mortality: A systematic review and meta‐analysis

Foroutan

Doumouras

Ross

et al. 2018

Clinical Transplantation

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The ISHLT's 2016 Guidelines on the selection of heart transplant (HT) candidates recommends weight loss prior to listing for persons with body mass (BMI) index greater than 35 kg/m . We conducted a systematic review to assess the impact of BMI on all-cause mortality. We searched to identify eligible observational studies that followed HT recipients. We used the GRADE system to quantify absolute effects and quality of evidence, and meta-analyzed survival curves to assess post-transplant mortality across BMI categories. We found a significantly increased risk of mortality in patients with BMI > 30 kg/m across all age categories, independently of transplant era and study source (BMI 30-34.9: HR 1.10, 95% CI 1.04-1.17; BMI ≥ 35: HR 1.24, 95% CI 1.12-1.38). We also found an increased risk of death in underweight (BMI < 18.5 kg/m ) candidates over 39 years of age (Age 40-65: HR 1.24, 95% CI 1.02-1.53; Age > 65: HR 1.70, 95% 1.13-2.57). We found obesity and underweight BMI to be associated with mortality post-HT. The similar and overlapping increased risk of mortality in patients with BMI 30-34.9 and BMI ≥ 35 does not support the recently updated ISHLT guidelines. Future evidence in the form of randomized controlled trials is required to assess effectiveness of interventions targeting obesity-related comorbidities and weight management.

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Section: Primary Findingssupporting

confidence: 56%

Section: Limitationssupporting

confidence: 56%

Impact of pretransplant recipient body mass index on post heart transplant mortality: A systematic review and meta‐analysis

Foroutan

Doumouras

Ross

et al. 2018

Clinical Transplantation

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“…In recipients with diabetes, there may be a combination of direct glucose-mediated endothelial damage, oxidative stress from superoxide overproduction and production of advanced glycation end-products, which may result in changes in endothelial permeability, excessive vascular protein deposition and altered blood flow (15). A recent metanalysis, diabetes mellitus was an independent predictor of 1-year mortality postheart transplant (16). They attributed this to the summative increased hazard for comorbidities of diabetes at time of transplant which was also noted by Russo et al (17).…”

Section: Risk Factorsmentioning

confidence: 99%

ISHLT Primary Graft Dysfunction Incidence, Risk Factors, and Outcome: A UK National Study

et al. 2019

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The incidence of ISHLT PGD was 36%. Thirty-day all-cause mortality in those with and without PGD was 31(19%) vs 13(4.5%) (p=0.0001). Donor, recipient and operative factors associated with PGD were: recipient diabetes mellitus (p=0.031), recipient preoperative BIVAD(p<0.001) and preoperative ECMO (p=0.023), female donor to male recipient gender mismatch(p=0.007) older donor age (p=0.010) and intracerebral haemorrhage/thrombosis in donor (p=0.023). Intra-operatively, implant time (p=0.017) and bypass time(p<0.001) were significantly longer in the PGD cohort. Perioperatively, patients with PGD received more blood products (p<0.001). Risk factors identified by multivariable logistic regression were donor age (p=0.014), implant time (p=0.038), female: male mismatch (p=0.033), recipient diabetes (p=0.051) and preoperative VAD/ECMO support (p=0.012), CONCLUSION: This is the first national study to examine the incidence and significance of PGD after heart transplantation using the ISHLT definition. PGD remains a frequent early complication of heart transplantation and is associated with increased mortality.

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“…The Wald test was used to assess whether the hazard of mortality between days 361 and 365 differed significantly from the following 14 or 30 days, using the preceding 14 or 30 days before day 361 to define the baseline hazard 11 . Risk adjustment for one‐year post‐transplant survival and graft failure was performed using variables that have been previously demonstrated to be associated with post‐transplant survival 12‐14 . Candidate covariates were included in the multivariable model if they correlated with the outcome on univariate analysis in the timeframe in question (14 or 30 days) at a P ‐value <.05 (Table S1).…”

Section: Methodsmentioning

confidence: 99%

Mortality trends around the one‐year survival mark after heart, liver, and lung transplantation in the United States

Nathan

Blebea

Chatterjee

et al. 2020

Clinical Transplantation

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Introduction One‐year post‐transplant survival is a significant quality measure for solid organ transplant programs in the United States. It is not known whether the use of this metric is associated with changes in life‐sustaining clinical practices that would delay mortality for solid organ recipients until just beyond the one‐year time point. Methods We compared trends in mortality in the time period immediately preceding the one‐year post‐transplant mark compared to the period immediately after using second‐order Cox proportional hazard regression models. Results Among recipients of heart, liver, and lung transplantation, mortality did not decrease significantly in the period immediately before day 365 or increase in the 14 days thereafter. There was an increased adjusted hazard of mortality in the 30 days following day 365 among lung transplant recipients (HR 1.33, 95% CI 1.03‐1.72, P = .03) with a 0.76% absolute mortality rate (94 deaths) in month 12 following lung transplantation and a 1.14% absolute mortality rate in month 13 (113 deaths). Conclusion Although we did not find evidence that life‐sustaining treatment is routinely continued until just beyond the one‐year mark in heart and liver transplantation recipients, there was an unexpected increased risk of mortality in the 30 days following day 365 among lung transplant recipients.

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Predictors of 1-year mortality in heart transplant recipients: a systematic review and meta-analysis

Cited by 65 publications

References 75 publications

Impact of pretransplant recipient body mass index on post heart transplant mortality: A systematic review and meta‐analysis

Impact of pretransplant recipient body mass index on post heart transplant mortality: A systematic review and meta‐analysis

ISHLT Primary Graft Dysfunction Incidence, Risk Factors, and Outcome: A UK National Study

Mortality trends around the one‐year survival mark after heart, liver, and lung transplantation in the United States

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