Patients bridged to transplant (BTT) with continuous-flow left ventricular assist devices (CF-LVADs) have increased in the past decade. Decision support tools for these patients are limited. We developed a risk score to estimate prognosis and guide decision-making. We included heart transplant recipients bridged with CF-LVADs from the United Network for Organ Sharing (UNOS) database and divided them into development (2,522 patients) and validation cohorts (1,681 patients). Univariate and multivariate Cox proportional hazards models were performed. Variables that independently predicted outcomes (age, African American race, recipient body mass index [BMI], intravenous [IV] antibiotic use, pretransplant dialysis, and total bilirubin) were assigned weight using linear transformation, and risk scores were derived. Patients were grouped by predicted posttransplant mortality: low risk (≤ 38 points), medium risk (38–41 points), and high risk (≥ 42 points). We performed Cox proportional hazards analysis on wait-listed CF-LVAD patients who were not transplanted. Score significantly discriminated survival among the groups in the development cohort (6.7, 12.9, 20.7; p = 0.001), validation cohort (6.4, 10.1, 13.6; p < 0.001), and ambulatory cohort (6.4, 11.5, 17.2; p < 0.001). We derived a left ventricular assist device (LVAD) BTT risk score that effectively identifies CF-LVAD patients who are at higher risk for worse outcomes after heart transplant. This score may help physicians weigh the risks of transplantation in patients with CF-LVAD.
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From the *Houston Methodist DeBakey Heart & Vascular Center, J. C. Walter Transplant Center at Houston Methodist Hospital, Houston, Texas; †Houston Methodist Research Institute, Department of Patho logy and Genomic Medicine, Houston Methodist Hospital, Houston, Texas; ‡Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; §Department of Surgery, J. C. Walter Transplant Center at Houston Methodist Hospital, Houston Methodist Hospital, Houston, Texas; ¶Department of Pharmacology, Therapeutics and Toxicology, Universitat Autonoma de Barcelona, Barcelona, Spain; ‖Department of Clinical Pharmacology, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain; #Catedra de Cardiologia y Medicina Vascular, Tecnologico de Monterrey, Nuevo Leon, Mexico.
Submitted for consideration December 2016; accepted for publication in revised form April 2017.
This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C.
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Disclosure: Ashrith Guha, Arvind Bhimaraj, Barry H. Trachtenberg, Eric Suarez, and Jerry D. Estep are consultants for Abbott Inc. Jerry D. Estep is a consultant for St. Jude Medical (St. Paul, MN). The other authors have no conflicts of interest to report.
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Correspondence: Ashrith Guha, MD, MPH, FACC, Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, 6560 Fannin Street, Houston, TX 77030. Email: firstname.lastname@example.org