Russo et al develop a score for determining a patient's risk following a combined heart and kidney transplant procedure. This can help identify a patient who may be better suited for the procedure so that scarce resources can be used more effectively. The authors are from Columbia University and Mount Sinai School of Medicine in New York City.
Patient selection: heart and renal failure being evaluated for heart and renal transplantation
Parameters based on pretransplantation status:
(1) recipient's age in years
(2) history of peripheral vascular disease
(3) cause for heart failure
(4) use of ventricular assist device (VAD) as a bridge to the transplant
(5) dialysis status at the time of the transplant
|
Parameter |
Finding |
Points |
|
age in years |
<= 65 years of age |
0 |
|
|
> 65 years of age |
3.5 |
|
history of peripheral vascular disease |
no |
0 |
|
|
yes |
4 |
|
cause of heart failure |
ischemic |
0 |
|
|
nonischemic |
2 |
|
VAD use |
not used |
0 |
|
|
used |
2 |
|
dialysis status |
not dependent |
0 |
|
|
dependent |
2.5 |
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 14
• The higher the score the greater the patient's risk following the transplant.
• The authors found that the only patients who had a survival benefit from the combined transplant procedure were those with a low risk score, heart failure and an estimated GFR < 33 per mL.
|
Total Score |
Risk |
1-Year Survival |
|
0 to 3.5 |
low |
93% |
|
4 to 6 |
moderate |
74% |
|
6.5 to 14 |
high |
62% |
Specialty: Cardiology, Surgery, general
ICD-10: ,
