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Original research article
Predictors of 1-year mortality in heart transplant recipients: a systematic review and meta-analysis
  1. Farid Foroutan1,2,
  2. Ana Carolina Alba1,
  3. Gordon Guyatt2,
  4. Juan Duero Posada1,
  5. Nicholas Ng Fat Hing1,
  6. Erika Arseneau2,
  7. Maureen Meade2,
  8. Steven Hanna2,
  9. Mitesh Badiwala1,
  10. Heather Ross1
  1. 1 Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
  2. 2 Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Farid Foroutan, HBSc Department of Clinical Epidemiology & Biostatistics, McMaster University 1280 Main St West, Hamilton, Ontario L8S 4L8, Canada; farid.foroutan{at}


Objective A systematic summary of the observational studies informing heart transplant guideline recommendations for selection of candidates and donors has thus far been unavailable. We performed a meta-analysis to better understand the impact of such known risk factors.

Methods We systematically searched and meta-analysed the association between known pretransplant factor and 1-year mortality identified by multivariable regression models. Our review used the Grading of Recommendations, Assessment, Development and Evaluation for assessing the quality of assessment. We pooled risk estimates by using random effects models.

Results Recipient variables including age (HR 1.16 per 10-year increase, 95% CI 1.10–1.22, high quality), congenital aetiology (HR 2.35, 95% CI 1.62 to 3.41, moderate quality), diabetes (HR 1.37, 95% CI 1.15 to 1.62, high quality), creatinine (HR 1.11 per 1 mg/dL increase, 95% CI 1.06 to 1.16, high quality), mechanical ventilation (HR 2.46, 95% CI 1.48 to 4.09, low quality) and short-term mechanical circulatory support (MCS) (HR 2.47, 95% CI 1.04 to 5.87, low quality) were significantly associated with 1-year mortality. Donor age (HR 1.20 per 10-year increase, 95% CI 1.14 to 1.26, high quality) and female donor to male recipient sex mismatch (HR 1.38, 95% CI 1.06 to 1.80, high quality) were significantly associated with 1-year mortality. None of the operative factors proved significant predictors.

Conclusion High-quality and moderate-quality evidence demonstrates that recipient age, congenital aetiology, creatinine, pulsatile MCS, donor age and female donor to male recipient sex mismatch are associated with 1-year mortality post heart transplant. The results of this study should inform future guideline and predictive model development.

  • heart transplantation
  • meta-analysis
  • systemic review

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  • Contributors FF, AA and HR conceived the study idea. FF, GG and AA coordinated the systematic review. FF wrote the first draft of the manuscript. AOC designed the search strategy. FF, JDP, NGFH and EA screened the abstracts and full texts, acquired the data and judged risk of bias in the studies. FF performed the data analysis. FF had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. FF is the guarantor. All authors interpreted the data analysis and critically revised the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.