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The adapted Heart Donor Score
Philipp Angleitner1, Alexandra Kaider2, Jacqueline M Smits3
1Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Insights
The adapted Heart Donor Score (aHDS) effectively predicts donor organ discard in the United Network for Organ Sharing (UNOS) system. While associated with survival, its significance diminishes in multivariable analysis, suggesting robust donor selection processes mitigate risks.
Area of Science:
- Cardiology
- Transplantation Science
- Biostatistics
Background:
- The Heart Donor Score (HDS) is utilized in the Eurotransplant system to assess donor heart viability and predict post-transplant survival.
- Adaptation of existing predictive models is crucial for optimizing organ allocation across different international registries.
Purpose of the Study:
- To adapt the Eurotransplant Heart Donor Score (HDS) for use within the United Network for Organ Sharing (UNOS) registry.
- To evaluate the performance of the adapted HDS (aHDS) in predicting donor organ discard and patient survival.
Main Methods:
- Modification of the HDS by excluding specific covariates (valve function, left-ventricular hypertrophy) and refining "compromised history" to create the aHDS.
- Analysis of two large datasets from the UNOS registry, encompassing donor organ discard (n=70,948) and survival (n=19,279) outcomes.
Main Results:
- The aHDS demonstrated a significant association with donor organ discard (OR 2.72, c-statistic 0.937), indicating strong predictive power.
- The aHDS performed consistently across different donor age groups (<60 and ≥60 years).
- Univariate analysis showed the aHDS as a significant predictor of survival (HR 1.04), though this lost significance in multivariable models.
Conclusions:
- The adapted Heart Donor Score (aHDS) is a reliable tool for predicting donor organ discard within the UNOS system.
- The study suggests that current donor selection protocols may mitigate the negative impact of aHDS components on long-term survival.
Abstract:
The Heart Donor Score (HDS) predicts donor organ discard for medical reasons and survival after heart transplantation (HTX) in the Eurotransplant allocation system. Our aim was to adapt the HDS for application in the United Network for Organ Sharing (UNOS) registry. To adjust for differences between the Eurotransplant and UNOS registries, the "adapted HDS" was created (aHDS) by exclusion of the covariates "valve function," "left-ventricular hypertrophy," and exclusion of "drug abuse" from the variable "compromised history." Two datasets were analyzed to evaluate associations of the aHDS with donor organ discard (n = 70 948) and survival (n = 19 279). The aHDS was significantly associated with donor organ discard [odds ratio 2.72, 95% confidence interval (CI) 2.68-2.76, P < 0.001; c-statistic: 0.937). The score performed comparably in donors <60 and ≥60 years of age. The aHDS was a significant predictor of survival as evaluated by univariate Cox proportional hazards analysis (hazard ratio 1.04, 95% CI 1.01-1.07, P = 0.023), although the association lost significance in a multivariable model. The aHDS predicts donor organ discard. Negative effects of most aHDS components on survival are likely eliminated by highly accurate donor selection processes.
