(521) Derivation and Validation of a Risk Prediction Model for Waitlist Mortality in Left Ventricular Assist Device Patients

Left ventricular assist devices (LVAD) are often used as a bridge to heart transplant (HT). Given limited availability of donor organs, discrimination of risk of waitlist mortality is important to inform prioritization on the wait list. Thus, we sought to derive and validate a risk prediction model...

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Bibliographic Details
Published in:	The Journal of heart and lung transplantation Vol. 42; no. 4; p. S237
Main Authors:	Tibrewala, A., Hu, M., Petito, L.C., Rich, J., Pham, D., De By, T., Gustafsson, F., Veen, K., Vanderheyden, M., Lloyd-Jones, D., Shah, S.
Format:	Journal Article
Language:	English
Published:	Elsevier Inc 01-04-2023
Online Access:	Get full text
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Summary:	Left ventricular assist devices (LVAD) are often used as a bridge to heart transplant (HT). Given limited availability of donor organs, discrimination of risk of waitlist mortality is important to inform prioritization on the wait list. Thus, we sought to derive and validate a risk prediction model for waitlist mortality in LVAD patients. Adult, continuous-flow, centrifugal durable LVAD patients listed or likely to be listed for HT in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) who were implanted between 2012-2017 and survived at least 3 months were included. The outcome was time to all-cause mortality. We considered 41 candidate predictors including demographics, clinical presentation, laboratory, and diagnostic values at 3-months post-implant. Univariate Fine-Gray models and four logistic regression techniques (logistic, LASSO, random forest, gradient boosting) were used for predictor selection. Variables were selected if their variable importance rank was 1-10 by at least 2 techniques. A final survival model was estimated with all selected predictors using the Fine-Gray method to account for competing risk of transplant. The model was validated in the same patient population from an independent cohort: the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). The derivation cohort had 2364 LVAD patients (76% male, 62% white), of whom 394 (16.7%) died within 1 year. A risk prediction model for wait list mortality at 1 year was derived with area-under-the-curve (AUC) of 0.726 (Table 1). The validation cohort had 577 patients with 37 (6.4%) deaths within 1 year; the associated AUC was 0.626. We derived and validated a risk prediction model for waitlist mortality in LVAD patients using two independent cohorts. As the transplant prioritization schemes evolve, studies like ours can provide additional data to inform waitlist prioritization for LVAD patients awaiting HT.
ISSN:	1053-2498 1557-3117
DOI:	10.1016/j.healun.2023.02.536