Cumulative Multidomain Vulnerability and Early Mortality After Heart Transplantation: Development and Temporal Evaluation of the RIGHT-HTx Framework

RIGHT-HTx shows that cumulative multidomain vulnerability predicts one-year mortality after heart transplantation, with 55.6% death in high-risk patients versus 8.1% in low-risk.

• Why it matters: Existing transplant risk models from high-income settings may not fit resource-constrained programmes with different recipient acuity, donor profiles, and limited mechanical circulatory support access.
• What they did: In a retrospective single-centre cohort of 436 adults (2012–2026), the seven-point Cox-derived RIGHT-HTx score integrated clinical acuity (INTERMACS 1–2) and graded renal dysfunction (eGFR 30–59 or 12 mmHg with donor-to-recipient weight ratio <1.0), then was applied unchanged to 79 subsequent recipients.
• The result: One-year mortality rose across risk categories (8.1%, 20.3%, 55.6%; log-rank P<0.001), and temporal discrimination was comparable (C-index 0.738), though observed mortality exceeded predictions (35.4% vs 25.4%; calibration slope 0.929).

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