Risk Prediction Models for Survival After Heart Transplantation

A Systematic Review

Natasha Aleksova; Ana C. Alba; Victoria M. Molinero; Katherine Connolly; Ani Orchanian-Cheff; Mitesh Badiwala; Heather J. Ross; Juan G. Duero Posada


American Journal of Transplantation. 2020;20(4):1137-1151. 

In This Article

Abstract and Introduction


Risk prediction scores have been developed to predict survival following heart transplantation (HT). Our objective was to systematically review the model characteristics and performance for all available scores that predict survival after HT. Ovid Medline and Epub Ahead of Print and In-Process & Other Non-Indexed Citations, Ovid Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Clinical Trials were searched to December 2018. Eligible articles reported a score to predict mortality following HT. Of the 5392 studies screened, 21 studies were included that derived and/or validated 16 scores. Seven (44%) scores were validated in external cohorts and 8 (50%) assessed model performance. Overall model discrimination ranged from poor to moderate (C-statistic/area under the receiver operating characteristics 0.54–0.77). The IMPACT score was the most widely validated, was well calibrated in two large registries, and was best at discriminating 3-month survival (C-statistic 0.76). Most scores did not perform particularly well in any cohort in which they were assessed. This review shows that there are insufficient data to recommend the use of one model over the others for prediction of post-HT outcomes.


Heart transplantation (HT) remains the standard of care for the management of end-stage heart failure, with the number and complexity of potential patients in need of organs expected to grow.[1] Because the average candidate is older with more comorbidities, an individualized risk assessment to maximize donor–recipient potential and survival is required.[1] Mortality on the HT waitlist has been reported as high as 10%-19%.[2,3] Although studies have suggested the use of older donors, extended donors or alternative donor allocation schema may decrease donor discard; this approach may lead to reduced recipient survival and an increase in posttransplant complications.[4–6]

Several risk prediction scores have been developed to predict short- and long-term survival following HT.[7] Although kidney and lung transplant programs have adopted risk scores as part of their organ sharing allocation, no single tool has been widely accepted for HT.[8,9] This systematic review describes and compares model characteristics and performance of all available scores that predict survival after HT in adults.