Objective

Heart transplantation is the only definitive therapy for end stage heart failure. Patients undergoing transplants require a bespoke perioperative management that is guided and optimised by a team of health professionals. However there is a lack of a scoring system specific to heart transplants with none majority focus solely on physiological parameters. The Glasgow Transplant Score (GTS) can qualitatively and quantitatively capture the multi-disciplinary assessment of heart failure patients.

Methods

The score was devised using a modified Delphi method. A multidisciplinary team of doctors and allied health professionals were involved in its formulation. Best evidence for each facet was compiled and a scoring system was devised for each of the parameters gauged. We validated this by retrospective analysis of 20 patients at our centre from 2012-2013. The GTS was compared to the additive Cardiac Intensive Care Score (CASUS) for correlation. Scores were taken at 24 and 120 hours post-operatively.

Results

Twenty (4M:F; 43.3±13.6yrs) heart transplants were performed between May 2012 and October 2013. The GTS score trended lower in patients with primary graft dysfunction (PGD) and in non-survivors (NS) at 24 (PGD 47.2±8.7 vs. 59.7±6.8; NS 42.3±5.1 vs 50.2±9.6) and at 120 hours (PGD 55.7±14.0 vs 82.3±5.0;NS 41.7±2.9 vs 62.8±15.5).There was an inverse correlation with the CASUS score at 24 (R=0.67,p=0.001) and 120 hours (R=0.781, p=0.0001).

Conclusion

GTS is a novel scoring tool of predictive prognostic value in selection and management of patients undergoing heart transplantation.