Functional Status Trajectory and Survival for Adult Patients Undergoing Heart Transplantation

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2025-02-08 DOI:10.1111/ctr.70107

Rachel E. Wittenberg, Elizabeth Mostofsky, Murray A. Mittleman

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Abstract

Background

Transplantation is a critical treatment for end-stage heart disease and improves length and quality of life. We investigated predictors of functional status improvement following transplant and the association between functional status trajectory and survival.

Methods

We conducted a retrospective cohort study using Scientific Registry of Transplant Recipients data on 34 009 US adults who underwent heart transplant 2006–2021. Functional status was measured using the Karnofsky Performance Scale (KPS; 0%–100%). Linear regression with stepwise selection was used to identify predictors of KPS trajectories. Kaplan–Meier curves and adjusted Cox proportional hazard models were used to compare survival.

Results

Mean KPS was low at listing (47.9%) and transplant (45.6%) and increased to 85.7% and 89.2% at 1- and 5-years posttransplant. Independent predictors of KPS trajectory in the first year included hypertension, diabetes, BMI, prior tobacco, previous malignancy, age, sex, education level, insurance type, etiology of heart disease, prior cardiac surgery, “1A” waitlist priority, and hospitalization status. KPS trajectory during the waitlist period and the first year posttransplant predicted survival, independent of baseline KPS. Decrease in KPS > −30% and −30% to < 0% in the first year were associated with 5.74 (3.45–9.56) and 2.09 (1.69–2.59) times higher mortality than stable KPS after adjusting for baseline KPS and other factors. Poor KPS trajectory in the waitlist period was similarly associated with higher mortality.

Conclusions

Functional status improvement is an important outcome following heart transplantation, and KPS trajectory predicts survival. Most patients achieve high KPS, but clinical and social interventions may optimize KPS trajectory for high-risk patients.

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成人心脏移植患者的功能状态轨迹和生存

背景：移植是治疗终末期心脏病的重要手段，可以延长患者的生命，提高患者的生活质量。我们研究了移植后功能状态改善的预测因素以及功能状态轨迹与生存之间的关系。方法：我们使用移植接受者科学登记处的数据，对2006-2021年接受心脏移植的34009名美国成年人进行了回顾性队列研究。功能状态采用Karnofsky绩效量表(KPS；0% - -100%)。采用逐步选择的线性回归方法确定KPS轨迹的预测因子。Kaplan-Meier曲线和校正Cox比例风险模型用于比较生存率。结果移植后1年和5年的平均KPS分别为85.7%和89.2%，移植后1年和5年的KPS分别为47.9%和45.6%。第一年KPS轨迹的独立预测因子包括高血压、糖尿病、BMI、既往吸烟、既往恶性肿瘤、年龄、性别、教育程度、保险类型、心脏病病因、既往心脏手术、“1A”等候名单优先级和住院情况。在等待名单期间和移植后第一年的KPS轨迹预测生存，独立于基线KPS。KPS >降低；−30%和−30%到<；在调整基线KPS和其他因素后，第一年的0%死亡率比稳定KPS高5.74（3.45-9.56）倍和2.09（1.69-2.59）倍。在等待名单期间，不良的KPS轨迹同样与较高的死亡率相关。结论功能状态改善是心脏移植术后的重要转归，KPS轨迹可预测生存。大多数患者的KPS较高，但临床和社会干预可能会优化高危患者的KPS轨迹。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.