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

Abstract

BackgroundHeart transplantation (HT) is the gold standard treatment for end-stage heart failure patients. However, the availability of donors limits the number of heart transplants. ObjectivesEvaluate donor and recipient risk factors associated with survival within one year of heart transplantation. MethodsA 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. ResultsChagas 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 prior to surgery were found to be statistically significant: maximum 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). ConclusionsThe study introduces a risk prediction score for one-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.