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Predictors of 1-year mortality in heart transplant recipients: a systematic review and meta-analysis
Farid Foroutan1,2, Ana Carolina Alba1, Gordon Guyatt2
1Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Insights
This meta-analysis identified key risk factors for 1-year mortality after heart transplantation. Recipient and donor characteristics like age, diabetes, and sex mismatch significantly impact survival, informing future transplant guidelines.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Statistics
Background:
- Heart transplantation is a life-saving procedure, but recipient and donor selection criteria require continuous refinement.
- Existing guidelines for heart transplant candidate and donor selection lack a systematic summary of observational study evidence.
- Understanding pretransplant risk factors is crucial for improving post-transplant outcomes.
Purpose of the Study:
- To systematically summarize observational studies on pretransplant risk factors associated with 1-year mortality after heart transplantation.
- To inform the development of future heart transplant guidelines and predictive models.
- To conduct a meta-analysis of known risk factors impacting heart transplant outcomes.
Main Methods:
- Systematic literature search and meta-analysis of observational studies.
- Inclusion of studies reporting multivariable regression models for pretransplant factors and 1-year mortality.
- Assessment of evidence quality using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.
- Pooling of risk estimates using random-effects models.
Main Results:
- Recipient factors significantly associated with 1-year mortality include age, congenital aetiology, diabetes, elevated creatinine, mechanical ventilation, and short-term mechanical circulatory support (MCS).
- Donor factors significantly associated with 1-year mortality include older donor age and female donor to male recipient sex mismatch.
- Operative factors did not emerge as significant predictors of 1-year mortality in this analysis.
Conclusions:
- High-quality evidence links recipient age, congenital aetiology, creatinine, pulsatile MCS, donor age, and sex mismatch to increased 1-year mortality post-heart transplant.
- These findings provide critical data for refining heart transplant selection criteria.
- The results underscore the need for updated predictive models and clinical guidelines in heart transplantation.
Objective:
A systematic summary of the observational studies informing heart transplant guideline recommendations for selection of candidates and donors has thus far been unavailable. We performed a meta-analysis to better understand the impact of such known risk factors.
Methods:
We systematically searched and meta-analysed the association between known pretransplant factor and 1-year mortality identified by multivariable regression models. Our review used the Grading of Recommendations, Assessment, Development and Evaluation for assessing the quality of assessment. We pooled risk estimates by using random effects models.
Results:
Recipient variables including age (HR 1.16 per 10-year increase, 95% CI 1.10-1.22, high quality), congenital aetiology (HR 2.35, 95% CI 1.62 to 3.41, moderate quality), diabetes (HR 1.37, 95% CI 1.15 to 1.62, high quality), creatinine (HR 1.11 per 1 mg/dL increase, 95% CI 1.06 to 1.16, high quality), mechanical ventilation (HR 2.46, 95% CI 1.48 to 4.09, low quality) and short-term mechanical circulatory support (MCS) (HR 2.47, 95% CI 1.04 to 5.87, low quality) were significantly associated with 1-year mortality. Donor age (HR 1.20 per 10-year increase, 95% CI 1.14 to 1.26, high quality) and female donor to male recipient sex mismatch (HR 1.38, 95% CI 1.06 to 1.80, high quality) were significantly associated with 1-year mortality. None of the operative factors proved significant predictors.
Conclusion:
High-quality and moderate-quality evidence demonstrates that recipient age, congenital aetiology, creatinine, pulsatile MCS, donor age and female donor to male recipient sex mismatch are associated with 1-year mortality post heart transplant. The results of this study should inform future guideline and predictive model development.
