Access to Heart Transplantation: A Proper Analysis of the Competing Risks of Death and Transplantation Is Required to Optimize Graft Allocation
Background. Heart allocation systems are usually urgency-based, offering grafts to candidates at high risk of waitlist mortality. In the context of a revision of the heart allocation rules, we determined observed predictors of 1-year waitlist mortality in France, considering the competing risk of tr...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2017-08-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000711 |
| _version_ | 1818941221125488640 |
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| author | Christelle Cantrelle, MS Camille Legeai, MD, MS Aurélien Latouche, PhD Philippe Tuppin, MD, PhD Carine Jasseron, PhD Laurent Sebbag, MD Olivier Bastien, MD, PhD Richard Dorent, MD |
| author_facet | Christelle Cantrelle, MS Camille Legeai, MD, MS Aurélien Latouche, PhD Philippe Tuppin, MD, PhD Carine Jasseron, PhD Laurent Sebbag, MD Olivier Bastien, MD, PhD Richard Dorent, MD |
| author_sort | Christelle Cantrelle, MS |
| collection | DOAJ |
| description | Background. Heart allocation systems are usually urgency-based, offering grafts to candidates at high risk of waitlist mortality. In the context of a revision of the heart allocation rules, we determined observed predictors of 1-year waitlist mortality in France, considering the competing risk of transplantation, to determine which candidate subgroups are favored or disadvantaged by the current allocation system.
Methods. Patients registered on the French heart waitlist between 2010 and 2013 were included. Cox cause-specific hazards and Fine and Gray subdistribution hazards were used to determine candidate characteristics associated with waitlist mortality and access to transplantation.
Results. Of the 2053 candidates, 7 variables were associated with 1-year waitlist mortality by the Fine and Gray method including 4 candidate characteristics related to heart failure severity (hospitalization at listing, serum natriuretic peptide level, systolic pulmonary artery pressure, and glomerular filtration rate) and 3 characteristics not associated with heart failure severity but with lower access to transplantation (blood type, age, and body mass index). Observed waitlist mortality for candidates on mechanical circulatory support was like that of others.
Conclusions. The heart allocation system strongly modifies the risk of pretransplant mortality related to heart failure severity. An in-depth competing risk analysis is therefore a more appropriate method to evaluate graft allocation systems. This knowledge should help to prioritize candidates in the context of a limited donor pool. |
| first_indexed | 2024-12-20T06:52:05Z |
| format | Article |
| id | doaj.art-ba57a15397ce4798b966177fcee3690b |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-12-20T06:52:05Z |
| publishDate | 2017-08-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-ba57a15397ce4798b966177fcee3690b2022-12-21T19:49:30ZengWolters KluwerTransplantation Direct2373-87312017-08-0138e19810.1097/TXD.0000000000000711201708000-0014Access to Heart Transplantation: A Proper Analysis of the Competing Risks of Death and Transplantation Is Required to Optimize Graft AllocationChristelle Cantrelle, MS0Camille Legeai, MD, MS1Aurélien Latouche, PhD2Philippe Tuppin, MD, PhD3Carine Jasseron, PhD4Laurent Sebbag, MD5Olivier Bastien, MD, PhD6Richard Dorent, MD71 Agence de la Biomédecine, Saint Denis, France.1 Agence de la Biomédecine, Saint Denis, France.2 Conservatoire National des Arts et Métiers, Paris, France.3 Caisse Nationale d’Assurance Maladie des Travailleurs Salariés, Paris, France.1 Agence de la Biomédecine, Saint Denis, France.4 Hospices Civils de Lyon, Lyon, France.1 Agence de la Biomédecine, Saint Denis, France.1 Agence de la Biomédecine, Saint Denis, France.Background. Heart allocation systems are usually urgency-based, offering grafts to candidates at high risk of waitlist mortality. In the context of a revision of the heart allocation rules, we determined observed predictors of 1-year waitlist mortality in France, considering the competing risk of transplantation, to determine which candidate subgroups are favored or disadvantaged by the current allocation system. Methods. Patients registered on the French heart waitlist between 2010 and 2013 were included. Cox cause-specific hazards and Fine and Gray subdistribution hazards were used to determine candidate characteristics associated with waitlist mortality and access to transplantation. Results. Of the 2053 candidates, 7 variables were associated with 1-year waitlist mortality by the Fine and Gray method including 4 candidate characteristics related to heart failure severity (hospitalization at listing, serum natriuretic peptide level, systolic pulmonary artery pressure, and glomerular filtration rate) and 3 characteristics not associated with heart failure severity but with lower access to transplantation (blood type, age, and body mass index). Observed waitlist mortality for candidates on mechanical circulatory support was like that of others. Conclusions. The heart allocation system strongly modifies the risk of pretransplant mortality related to heart failure severity. An in-depth competing risk analysis is therefore a more appropriate method to evaluate graft allocation systems. This knowledge should help to prioritize candidates in the context of a limited donor pool.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000711 |
| spellingShingle | Christelle Cantrelle, MS Camille Legeai, MD, MS Aurélien Latouche, PhD Philippe Tuppin, MD, PhD Carine Jasseron, PhD Laurent Sebbag, MD Olivier Bastien, MD, PhD Richard Dorent, MD Access to Heart Transplantation: A Proper Analysis of the Competing Risks of Death and Transplantation Is Required to Optimize Graft Allocation Transplantation Direct |
| title | Access to Heart Transplantation: A Proper Analysis of the Competing Risks of Death and Transplantation Is Required to Optimize Graft Allocation |
| title_full | Access to Heart Transplantation: A Proper Analysis of the Competing Risks of Death and Transplantation Is Required to Optimize Graft Allocation |
| title_fullStr | Access to Heart Transplantation: A Proper Analysis of the Competing Risks of Death and Transplantation Is Required to Optimize Graft Allocation |
| title_full_unstemmed | Access to Heart Transplantation: A Proper Analysis of the Competing Risks of Death and Transplantation Is Required to Optimize Graft Allocation |
| title_short | Access to Heart Transplantation: A Proper Analysis of the Competing Risks of Death and Transplantation Is Required to Optimize Graft Allocation |
| title_sort | access to heart transplantation a proper analysis of the competing risks of death and transplantation is required to optimize graft allocation |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000711 |
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