ESC heart failure
Prognostic value of Fibrosis-4 Index and preoperative dynamic changes in heart transplantation
By Lai J, Shan Y, Yim WY and 13 others.
Abstract
Introduction
The Fibrosis-4 (FIB-4) Index has shown prognostic value in cardiovascular diseases, but its role in heart transplantation (HTx) and the impact of dynamic preoperative changes remain unclear. This study evaluated the prognostic value of preoperative FIB-4 for mortality after HTx and investigated whether dynamic changes in FIB-4 before transplantation are associated with post-transplant survival.
Methods
This single-centre retrospective cohort study included 791 adult patients who underwent orthotopic HTx between January 2015 and December 2024, with follow-up through June 2025. Patients were stratified by preoperative FIB-4 into low (<1.30), intermediate (1.30-2.67), and high (>2.67) risk groups. The primary outcome was all-cause mortality. Analyses employed Cox models, restricted cubic splines, and five machine learning survival models, including Random Survival Forest (RSF).