Factors predicting increased 1-year mortality among heart transplant recipients
Recipient and donor age, congenital aetiology, creatinine, pulsatile mechanical circulatory support (MCS), and donor-recipient gender mismatch all contribute to an increase in 1-year mortality among heart transplant recipients, according to a study.
Researchers performed a systematic review and meta-analysis of 62 studies including 282,367 heart recipients transplanted between 1983 and 2013. Males comprised the majority of both recipients (67 to 91) and donors (49 to 72 percent), and the mean age ranged from 32 to 55 years among donors and 29 to 44 years among recipients.
About half of the included studies specified 1 year as the time point of interest for outcome, with 93.6 percent reporting on all-cause mortality. The median risk of 1-year mortality was 15 percent.
In random-effects models, pooled risk estimates showed 1-year mortality to be significantly associated with recipient variables including age (hazard ratio [HR], 1.16 per 10-year increase; 95 percent CI, 1.10 to 1.22), congenital aetiology (HR, 2.35; 1.62 to 3.41), diabetes (HR, 1.37; 1.15 to 1.62), creatinine (HR, 1.11 per 1-mg/dL increase; 1.06 to 1.16), mechanical ventilation (HR, 2.46; 1.48 to 4.09) and short-term MCS (HR, 2.47; 1.04 to 5.87). Quality of evidence was moderate to high.
Among donor-related factors, age (HR, 1.20 per 10-year increase; 1.14 to 1.26) and female donor to male recipient sex mismatch (HR, 1.38; 1.06 to 1.80) were significantly associated with 1-year mortality. Quality of evidence was high.
None of the operative factors emerged as significant predictors of 1-year mortality.
Findings of the present study should inform future guideline and predictive model development, as well as the decision-making process undertaken between the clinician and patient, researchers said.
While the International Society of Heart and Lung Transplantation 2016 guidelines recommend that transplantation be considered for carefully selected candidates >70 years of age (class I, level of evidence: C), “our review suggests that increasing donor age and recipient age carries a 1-year mortality hazard of 20 and 16 percent for each 10-year increase, respectively. Hence, matching older recipients with older donors puts patients at a higher risk of 1-year mortality,” they said.
Nevertheless, more studies with better methodology are needed to reassess predictors of 1-year mortality, they added.