Statistical performance of 16 posttransplant risk scores in a contemporary cohort of heart transplant recipients
Accurate risk stratification of early heart transplant failure is required to avoid futile transplants and rationalize donor selection. We aimed to evaluate the statistical performance of existing risk scores on a contemporary cohort of heart transplant recipients.
After an exhaustive search, we identified 16 relevant risk scores. From the UNOS database, we selected all first noncombined adult heart transplants performed between 2014 and 2017 for validation. The primary endpoint was death or retransplant during the first year posttransplant.
For all scores, we analyzed their association with outcomes, sensitivity, specificity, likelihood ratios, and discrimination (concordance index and overlap of individual scores). The cohort included 9396 patients. All scores were significantly associated with the primary outcome (P < .001 for all scores). Their likelihood ratios, both negative and positive, were poor. The discriminative performance of all scores was limited, with concordance index ranging from 0.544 to 0.646 (median 0.594) and an important overlap of individual scores between patients with or without the primary endpoint. Subgroup analyses revealed important variation in discrimination according to donor age, recipient age, and the type of assist device used at transplant.
Our findings raise concerns about the use of currently available scores in the clinical field.
Identification and characterization of trajectories of cardiac allograft vasculopathy after heart transplantation
One of the most common reasons for long-term graft failure and patient death is an accelerated form of coronary artery disease called cardiac allograft vasculopathy. It is a frequent complication that affects up to half of patients within 10 years following heart transplantation. Yet, until now, little has been known about the different evolutive profiles of cardiac allograft vasculopathy and their risk factors.
The team of the Paris Transplant Group has been awarded at the ESOT 2019 congress in Copenhagen for its many contribution in the field of transplantation.
The Prize is given to a single Institution having submitted at least 5 abstracts for the event and granted with the best score. The Paris Transplant Group is very pleased to won this European award twice in a row.
Check out the contribution submitted by the Group on the ESOT website: esotcongress.org.
Paris Transplant Group
Our global aim is to accelerate the translation of immunological and gene expression discoveries into the clinical field by filling the gap between basic science and applied biomedical researches.