Donor scoring system for heart transplantation and the impact on patient survival

作者：Smits Jacqueline M^*; De Pauw Michel; de Vries Erwin; Rahmel Axel; Meiser Bruno; Laufer Guenther; Zuckermann Andreas

来源：Journal of Heart and Lung Transplantation, 2012, 31(4): 387-397.

DOI：10.1016/j.healun.2011.11.005

• extended criteria donor hearts
• heart donor quality score
• heart transplantation
• donor risk assessment
• heart allocation

BACKGROUND: The aim of this study was to design and validate a heart donor score that reflects experts' perceived risk of allograft failure.
METHODS: All heart donors reported to Eurotransplant between January 1, 2005 and December 31, 2008 (N = 4,110) were used to create a donor score. Based on observed discard rates and using multivariate regression, points were assigned for the following donor factors: age; cause of death; body mass index (BMI); diabetes mellitus (DM); duration of ICU stay; compromised history (drug, abuse, sepsis, meningitis, malignancy, HBsAg(+) or anti-HCV+); hypertension; cardiac arrest; echocardiography; coronary angiogram; serum sodium; and noradrenaline and dopamine/dobutamine doses. The donor score was obtained by adding all points. All heart donors reported to Eurotransplant in 2009 were included to validate the score (N = 885).
RESULTS: All donor factors, except BMI, DM and duration of ICU stay, significantly predicted discard. Based on the median value of the score, donors were classified into low-risk donors (LRDs: <= 16 points) and high-risk donors (HRDs: >= 17 points). In the validation set, discard rates were significantly different when comparing HRDs (35%) and LRDs (7%) (p < 0.0001). In addition, the heart donor score was significantly associated with 3-year survival: LRD 81.5% vs HRD 70.0% (p = 0.004).
CONCLUSIONS: The heart donor score accurately reflects the likelihood of organ acceptance and predicts long-term patient mortality. Application of this score at time of donor reporting may facilitate donor risk assessment and allow for more appropriate matching of extended criteria donor hearts.

• 出版日期2012-4