Scoring System: Survival to Transplant and Death While on Waitlist for Patients without LVADs

Purpose Transplant strategies are in flux as recipients of LVADs are now de-prioritized under new allocation system changes. Here we sought to create a scoring system to predict survival to heart transplantation(Htx) while on the waitlist for patients without LVADs. Methods We performed a retrospective analysis of adult patients listed for primary Htx from 2008-2018 using the UNOS database. Patient's with LVADs at listing, or who received LVADs while listed were excluded. Cox Proportional Hazards analysis was used on patient data at the time of listing to determine Survival-to-Transplant (STT) and Death-While-Waitlisted (DWW). Risk scores were calculated for each of these metrics, assigning approximately 1 point for each 0.1 increase in hazard ratio. Fractional polynomial regression analysis was used to demonstrate risk of death while waitlisted and survival to Htx. Results Of the 27,242 patients included, 15,972 (58.6%) successfully underwent Htx, while 5,574 (20.5%) died before transplant; the remainder (5,696, 20.1%) remain on the waitlist or have been unlisted. Point system for DWW and STT are demonstrated in Table 1, and Figure 1a/b outlines their probability of STT or DWW for these scores. Patients with DWW scores of ≤ 2 had 14.0% rate of death before transplant, 3-5 had 16.6%, 6-7 had 18.8%, 8-20 had 23.6%, and 21+ had 35.2%. Patients with STT score Conclusion Patients should be informed of their chances of successful Htx or death while waitlisted when selecting management options for their heart failure.