Transplant Trial Watch

The Houston Methodist Lung Transplant Risk Model: A Validated Tool for Pretransplant Risk Assessment.

Chan, E. Y., Nguyen, D. T. et al. (2019).

Annals of Thoracic Surgery 108(4): 1094-1100.


Aims
This study aimed to create a risk stratification model using preoperative recipient data to predict 1-year postoperative mortality during the pre-transplant assessment.

Interventions
Recipients from Houston Methodist Hospital were randomized into development (n = 317 patients) and validation cohorts (n = 316).

Participants
Patients aged 18 years and over who underwent lung transplantation from January 1, 2009 through December 31, 2014, at Houston Methodist Hospital in Houston.

Outcomes
The primary outcome measured was survival at 1 year after lung transplantation.

Follow-up
1 year

CET Conclusions
This study used UNOS data from lung transplant recipients transplanted in Houston over a 5-year period to derive a risk model (using only recipient variables) for post-transplant 1-year survival. The model was validated using a random subset of the cohort, and externally validated using UNOS data from other centres. The model derived was able to discriminate low/moderate and high-risk candidates. The methodology here is good, with both internal and external validation. The discriminatory power of the model is reasonable, but even high risk candidates in the UNOS data had 82% 1-year survival meaning that it is not useful for decision making regarding transplant suitability in isolation.

Jadad score
2

Data analysis
Strict intention-to-treat analysis

Allocation concealment
Yes

Trial registration
N/A

Funding source
Non-industry funded