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Published on: August 25, 2015
Towards a cardiac allocation score: a retrospective calculation for 73 patients from a German transplant center
Sebastian Claes1, Michael Berchtold-Herz2, Qian Zhou1
1Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
Insights
A new Cardiac Allocation Score (CAS) shows potential for prioritizing heart transplant candidates in Germany. This score, including predicted survival, could shift current allocation practices, potentially favoring T-status over high urgency patients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Health Policy
Background:
- Declining heart donor rates in Germany increase the gap between transplant waiting lists and available organs.
- Current heart transplant allocation prioritizes medical urgency and waiting time, leading to most transplants in critically ill patients.
- A proposed Cardiac Allocation Score (CAS) incorporates predicted post-transplant survival, potentially altering allocation dynamics.
Purpose of the Study:
- To evaluate the distribution and clinical relevance of a hypothetical Cardiac Allocation Score (CAS) in a German heart transplant patient cohort.
- To assess the suitability of the IMPACT-score within the CAS for predicting post-transplant survival.
- To explore the potential impact of implementing CAS on current organ allocation practices.
Main Methods:
- A retrospective analysis was conducted on 73 heart transplant recipients at a German medium-volume center.
- A hypothetical Cardiac Allocation Score (CAS) was calculated for each patient based on a recently published Eurotransplant algorithm.
- The IMPACT-score, a component of the CAS, was analyzed for its predictive accuracy of post-transplant survival.
Main Results:
- The hypothetical CAS exhibited a relatively normal distribution (median 32.91, mean 31.95 ±10.02) in the studied cohort.
- CAS scores were generally lower than those reported for high urgency patients in other cohorts, with significant overlap between high urgency (HU) and T-status patients.
- Patients supported by a ventricular assist device (VAD) had lower CAS values compared to non-VAD supported patients. The IMPACT-score demonstrated suitability for predicting outcomes.
Conclusions:
- The proposed Cardiac Allocation Score (CAS) demonstrates a normal distribution of priority values within this German patient cohort.
- The IMPACT-score component of the CAS effectively predicted post-transplant survival in a real-world, single-center setting.
- Implementing CAS could significantly alter organ allocation, potentially prioritizing T-status patients over current high urgency (HU) patients.
Background:
Due to a growing discrepancy between the transplant waiting list and decreasing numbers of available donor hearts, cardiac transplantation rates in Germany have been declining in the past years. Currently, patients on the waiting list are prioritized by medical urgency and waiting time and therefore a majority of all cardiac transplants is performed in very ill patients. Recently, a different allocation algorithm was proposed that included predicted post-transplant survival as a parameter for organ allocation. So far, little data exists on how such a "Cardiac Allocation Score" (CAS) relates to our current transplant patient population and on how such a change in organ allocation could change clinical practice.
Methods:
We calculated a theoretical retrospective Cardiac Allocation Score for 73 patients recruited and transplanted at our medium-volume center in Germany based on a hypothetical scoring algorithm recently published by Eurotransplant.
Results:
Overall, 37 patients (50.7%) were transplanted on high urgency status (HU), 27 (37%) were being supported by a VAD at time of transplant. 57 (78.1%) were male. We found a relatively normal distribution of the hypothetical CAS with a median of 32.91 and a mean of 31.95 +/-10.02. Overall, CAS-Scores were lower than previously described for a Eurotransplant patient cohort of high urgency patients, but there was a significant overlap in score values between patients on HU and T status. CAS-values of VAD-supported patients were lower than in patients without mechanical support. The IMPACT-score as part of the CAS was used for prediction of post-transplant survival and seems suitable to predict outcome in our patient population.
Conclusion:
In a retrospective analysis, the recently proposed Cardiac Allocation Score seems to show a normal distribution of priority values in our patient cohort. The IMPACT-score predicted outcome after transplantation and could serve as part of the CAS-algorithm to predict post-transplant survival in this single center real-world scenario. Implementation of the CAS could significantly change organ allocation practice, including a potential prioritization of current T-status patients over HU-status patients.
