Practical application of the French two-score heart allocation scheme: Insights from a high-volume heart transplantation centre - 31/03/23

Doi : 10.1016/j.acvd.2023.02.004

Lucie Daniel ^a,^{^{1
These authors have contributed equally.}}, Eva Desiré ^a,^b,^{^{1
These authors have contributed equally.}}, Mickaël Lescroart ^a, Clément Jehl ^a, Pascal Leprince ^a,^b, Shaida Varnous ^a, Guillaume Coutance ^a,^c,^⁎
^a Department of cardiac and thoracic surgery, cardiology Institute, Pitié-Salpêtrière hospital, Sorbonne university medical school, AP–HP, 75013 Paris, France
^b Inserm, UMRS 1166-ICAN, Institute of cardiometabolism and nutrition, 75013 Paris, France
^c Inserm, UMRS-970, Paris translational research centre for organ transplantation, 75015 Paris, France

^⁎Corresponding author. Institut de cardiologie, GH Pitié-Salpêtrière, 52, boulevard Vincent-Auriol, 75013 Paris, France.Institut de cardiologie, GH Pitié-Salpêtrière52, boulevard Vincent-AuriolParis75013France

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Graphical abstract

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Highlights

•	Bilirubin and natriuretic peptides had major weight in the pretransplant risk score.
•	Pretransplant risk score had an important impact on waitlist outcomes.
•	A limited proportion of candidates were ineligible for transplantation at listing.
•	The number of contraindicated donor categories had an impact on waitlist outcomes.
•	Discrimination of post-transplant risk score was limited (adequate calibration).

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Abstract

Background

In 2018, a cardiac allocation scheme based on an individual score considering the risk of death both on the waitlist and after heart transplantation was implemented in France.

Aims

To analyse the practical application of the pre- and post-transplant risk score in a French high-volume heart transplantation centre.

Methods

All consecutive adult patients listed for a first non-combined heart transplantation between 02 January 2018 and 30 June 2022 at our centre were included. Baseline characteristics of candidates and recipients were retrieved from the national CRISTAL registry. Both scores were calculated at listing and at transplant.

Results

Overall, 364 patients were included. During follow-up, 257 patients (70.6%) were transplanted, and 57 (15.6%) died or were removed from the waitlist. Post-transplant 3-month survival was 84.8%. Total bilirubin and natriuretic peptides had the most important weight in the pretransplant risk score. This score had a major impact on waitlist outcomes: quartile 1 was characterized by low access to heart transplantation (58.2%) and risk of death on the waitlist (9.9%) compared with quartile 4 (heart transplantation rate 74.1%, mortality on the waiting list>20%). According to the post-transplant risk score, a minimal number of candidates were considered ineligible for heart transplantation (<1%), but 12.4% were contraindicated to at least one donor category. The number of contraindicated donor categories had a significant impact on waitlist outcomes. Although adequately calibrated, the post-transplant score had a limited discrimination (area under the curve 0.65, 95% confidence interval 0.59–0.71).