Red blood cell distribution width to predict mortality in heart transplant recipients: a systematic review

Red blood cell distribution width (RDW) has been shown to have prognostic value in a number of different clinical settings, such as cardiovascular disease, including heart failure. However, its prognostic value in heart transplant (HT) recipients remains unknown. The aim of this systematic review is to determine the prognostic value of pre-transplant RDW for mortality in HT recip-ients. There is a pre-published protocol of this review. The terms "Heart transplant", "Red cell distribution width" and their syn-onyms were used in the search strategy. PubMed/Medline, Embase, Scopus, Web of Science and LILACS were searched until May 17th, 2022, without date or language restrictions. Two authors independently carried out the selection, first by title and abstract, second by full-text revision. Discrepancies were dis-cussed and resolved with three other authors. Quality of individual studies was assessed with Newcastle Ottawa Scale (NOS) for cohorts. After removing the duplicates, 3885 articles were identi-fied. Four articles were included in the qualitative synthesis. Three studies were classified as "good quality": whereas one as "poor quality" according to NOS scale. All the included articles evaluat-ed long-term mortality and one study also evaluated short-term mortality. In this one, a correlation between higher RDW values and short-term mortality was reported. Meanwhile, in all the stud-ies, a high pre-HT RDW was a marker of long-term mortality fol-lowing cardiac transplantation. Our review shows that an elevated on-admission RDW is associated with long-term mortality in heart transplantation recipients.