Importance of Transplant Era on Post–Heart Transplant Predictive Models: A UNOS Cohort Analysis

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-07-18 DOI:10.1111/ctr.15403

Mickaël Lescroart, Evan P. Kransdorf, Maria Francesca Scuppa, Jignesh K. Patel, Guillaume Coutance

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引用次数: 0

Abstract

Background

The application of posttransplant predictive models is limited by their poor statistical performance. Neglecting the dynamic evolution of demographics and medical practice over time may be a key issue.

Objectives

Our objective was to develop and validate era-specific predictive models to assess whether these models could improve risk stratification compared to non–era-specific models.

Methods

We analyzed the United Network for Organ Sharing (UNOS) database including first noncombined heart transplantations (2001–2018, divided into four transplant eras: 2001–2005, 2006–2010, 2011–2015, 2016–2018). The endpoint was death or retransplantation during the 1st-year posttransplant. We analyzed the dynamic evolution of major predictive variables over time and developed era-specific models using logistic regression. We then performed a multiparametric evaluation of the statistical performance of era-specific models and compared them to non–era-specific models in 1000 bootstrap samples (derivation set, 2/3; test set, 1/3).

Results

A total of 34 738 patients were included, 3670 patients (10.5%) met the composite endpoint. We found a significant impact of transplant era on baseline characteristics of donors and recipients, medical practice, and posttransplant predictive models, including significant interaction between transplant year and major predictive variables (total serum bilirubin, recipient age, recipient diabetes, previous cardiac surgery). Although the discrimination of all models remained low, era-specific models significantly outperformed the statistical performance of non–era-specific models in most samples, particularly concerning discrimination and calibration.

Conclusions

Era-specific models achieved better statistical performance than non–era-specific models. A regular update of predictive models may be considered if they were to be applied for clinical decision-making and allograft allocation.

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移植年代对心脏移植后预测模型的重要性：UNOS 队列分析。

背景：移植后预测模型的应用因其较差的统计性能而受到限制。忽略人口统计学和医疗实践随时间的动态演变可能是一个关键问题：我们的目标是开发和验证针对不同年龄的预测模型，以评估这些模型与非针对不同年龄的模型相比能否改善风险分层：我们分析了器官共享联合网络（UNOS）数据库，其中包括首次非合并心脏移植（2001-2018年，分为四个移植年代：2001-2005年、2006-2010年、2011-2015年、2016-2018年）。终点是移植后第一年内的死亡或再移植。我们分析了主要预测变量随时间的动态演变，并使用逻辑回归建立了特定时代的模型。然后，我们对时代特异性模型的统计性能进行了多参数评估，并在1000个引导样本（衍生集，2/3；测试集，1/3）中将其与非时代特异性模型进行了比较：共纳入 34 738 例患者，3670 例患者（10.5%）达到了综合终点。我们发现移植年代对供者和受者的基线特征、医疗实践和移植后预测模型有显著影响，包括移植年份与主要预测变量（血清总胆红素、受者年龄、受者糖尿病、既往心脏手术）之间的显著交互作用。虽然所有模型的分辨力仍然较低，但在大多数样本中，特定年代模型的统计性能明显优于非特定年代模型，尤其是在分辨力和校准方面：结论：年代特异性模型比非年代特异性模型具有更好的统计性能。如果要将预测模型应用于临床决策和异体移植分配，可以考虑定期更新模型。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.