Donor risk analysis and validation in heart transplants: a single-centre experience

Area of Science:

• Cardiology
• Transplantation Medicine
• Medical Informatics

Background:

• Heart transplantation (Htx) is the optimal treatment for end-stage heart failure.
• Limited organ availability necessitates improved donor selection and allocation strategies.
• Donor risk scores aim to predict post-transplant outcomes and optimize organ utilization.

Purpose of the Study:

• To evaluate the performance of United Network for Organ Sharing (UNOS), RADIAL, and Eurotransplant donor scoring models.
• To compare these models in predicting early and late outcomes in an Italian heart transplant population.
• To identify key donor and recipient risk factors influencing transplant success.

Main Methods:

• Retrospective analysis of 461 adult heart transplant recipients between 2000 and 2017.
• Calculation and validation of UNOS, RADIAL, and Eurotransplant donor risk scores.
• Multivariable analysis to identify independent predictors of in-hospital, early, and late mortality.

Main Results:

• Early graft failure occurred in 16.1% of patients; 11.1% required extracorporeal life support.
• Donor noradrenaline use and ischemic time >240 minutes negatively impacted early outcomes.
• RADIAL score predicted early and late mortality, UNOS score predicted late mortality, Eurotransplant score did not impact outcomes.
• Donor noradrenaline infusion, recipient age, and preoperative extracorporeal membrane oxygenation were independent predictors of mortality.

Conclusions:

• Existing donor scoring systems demonstrated limited reliability in predicting heart transplant outcomes in this cohort.
• A 'local only' graft selection approach, considering specific donor and recipient variables, is recommended.
• Careful monitoring of identified risk factors is essential for accurate prediction of early and late transplant outcomes.