{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T21:03:44Z","timestamp":1793480624019,"version":"4.5.0"},"reference-count":52,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2024,2,13]]},"abstract":"<jats:sec id=\"ab-joi230162-4\"><jats:title>Importance<\/jats:title><jats:p>The US heart allocation system prioritizes medically urgent candidates with a high risk of dying without transplant. The current therapy-based 6-status system is susceptible to manipulation and has limited rank  ordering ability.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230162-5\"><jats:title>Objective<\/jats:title><jats:p>To develop and validate a candidate risk score that incorporates current clinical, laboratory, and hemodynamic data.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230162-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>A registry-based observational study of adult heart transplant candidates (aged \u226518 years) from the US heart allocation system listed between January 1, 2019, and December 31, 2022, split by center into training (70%) and test (30%) datasets. Adult candidates were listed between January 1, 2019, and December 31, 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230162-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>A US candidate risk score (US-CRS) model was developed by adding a predefined set of predictors to the current French Candidate Risk Score (French-CRS) model. Sensitivity analyses were performed, which included intra-aortic balloon pumps (IABP) and percutaneous ventricular assist devices (VAD) in the definition of short-term mechanical circulatory support (MCS) for the US-CRS. Performance of the US-CRS model, French-CRS model, and 6-status model in the test dataset was evaluated by time-dependent area under the receiver operating characteristic curve (AUC) for death without transplant within 6 weeks and overall survival concordance (c-index) with integrated AUC.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230162-8\"><jats:title>Results<\/jats:title><jats:p>A total of 16\u202f905 adult heart transplant candidates were listed (mean [SD] age, 53 [13] years; 73% male; 58% White); 796 patients (4.7%) died without a transplant. The final US-CRS contained time-varying short-term MCS (ventricular assist\u2013extracorporeal membrane oxygenation or temporary surgical VAD), the log of bilirubin, estimated glomerular filtration rate, the log of B-type natriuretic peptide, albumin, sodium, and durable left ventricular assist device. In the test dataset, the AUC for death within 6 weeks of listing for the US-CRS model was 0.79 (95% CI, 0.75-0.83), for the French-CRS model was 0.72 (95% CI, 0.67-0.76), and 6-status model was 0.68 (95% CI, 0.62-0.73). Overall c-index for the US-CRS model was 0.76 (95% CI, 0.73-0.80), for the French-CRS model was 0.69 (95% CI, 0.65-0.73), and 6-status model was 0.67 (95% CI, 0.63-0.71). Classifying IABP and percutaneous VAD as short-term MCS reduced the effect size by 65%.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230162-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this registry-based study of US heart transplant candidates, a continuous multivariable allocation score outperformed the 6-status system in rank ordering heart transplant candidates by medical urgency and may be useful for the medical urgency component of heart allocation.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2023.27029","type":"journal-article","created":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T16:36:24Z","timestamp":1707842184000},"page":"500","source":"Crossref","is-referenced-by-count":46,"title":["Development and Validation of a Risk Score Predicting Death Without Transplant in Adult Heart Transplant Candidates"],"prefix":"10.1001","volume":"331","author":[{"given":"Kevin C.","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Medicine, 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