Perspective on a Risk Score for Cardiac Transplantation

Abstract

In this issue of Circulation: Heart Failure , “Preoperative Assessment of High-Risk Candidates to Predict Survival After Heart Transplantation”1 presents a sophisticated statistical analysis of multiple pretransplantation factors that influence postoperative survival in 711 regular and 111 alternate list cardiac recipients transplanted between 1999 and 2010. They found that increasing donor age is associated with increasing recipient mortality. They previously looked at ischemic time2 and found an age-related tolerance to ischemia with better tolerance in younger donor hearts. Article see p 527 The application of the CARRS scoring model, using 5 pretransplant risk factors (C for prior CVA, A for albumin 2 prior sternotomies with 2 points for each, except renal with 1 point) sorted out high and low survival groups. For low-scoring ( 4 the 1-year survival rate was 12 000 United Network for Organ Sharing (UNOS) database patients found a significant difference in survival between groups using a cutoff point of CARRS <3. The patients in the study had already been selected. The CARRS score sorted out the high-risk patients. This scoring system using 5 factors seems to be a powerful addition, but can we distill …