Risk Index Predicts Pediatric Heart Allograft Non-Utilization

Area of Science:

• Pediatric Cardiology
• Transplant Surgery
• Organ Donation

Background:

• Pediatric heart transplant recipients face the highest waitlist mortality (14%) among solid organ transplant patients.
• Reducing donor heart allograft non-utilization (41.5%) could significantly decrease waitlist mortality for children awaiting transplants.

Purpose of the Study:

• To quantify the risk of pediatric donor heart allograft non-utilization at the time of initial offering.
• To develop a predictive tool for donor heart non-utilization.

Main Methods:

• Retrospective analysis of 8823 deceased pediatric donors (≤18 years) using the UNOS database.
• Univariable, multivariable analysis, and logistic regression models were employed.
• A pediatric non-utilization risk index (pDRSI) was created using significant predictors.

Main Results:

• 17 factors significantly predicted pediatric heart non-utilization in multivariable analysis.
• Low left ventricular ejection fraction (OR 35.3) and hepatitis C positive donor (OR 23.3) were the strongest predictors.
• The pDRSI demonstrated strong predictive accuracy with a C-statistic of 0.80 in both training and validation sets.

Conclusions:

• The developed pDRSI effectively predicts the risk of pediatric donor heart allograft non-utilization.
• Utilizing this index can aid in optimizing donor heart allocation and potentially reduce waitlist mortality.