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Risk Index Predicts Pediatric Heart Allograft Non-Utilization
Jake Lynn1, Tahir Malik2, Ashley Montgomery1
1Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA.
Insights
Pediatric heart transplant waitlist mortality is high. A new risk index identifies factors like low ejection fraction and hepatitis positivity to predict donor heart non-utilization, potentially saving lives.
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.
Background:
Children listed for heart transplantation face the highest waitlist mortality among all solid organ transplant patients (14%). Attempts at decreasing donor allograft non-utilization (41.5%) could potentially decrease waitlist mortality for pediatric heart transplant patients. Our aim was to quantify the non-utilization risk of pediatric donor heart allografts at the time of initial offering.
Methods:
Using the United Network of Organ Sharing (UNOS) database, we retrospectively analyzed 8823 deceased donors (≤18 years old) data through univariable and multivariable analysis and logistic regression models. These factors were divided into a training (n = 5882) and validation set (n = 2941). Donor clinical characteristics and laboratory values were used to predict non-utilization of donor hearts. The multivariable analysis used factors that were significant from the univariable analysis (p-value < .05), and the pediatric non-utilization risk index (pDRSI) included significant factors from the multivariable analysis, producing an overall risk score for non-utilization. With these data, we created a non-utilization risk index to predict likelihood of donor allograft non-utilization.
Results:
From the 24 potential factors that were identified from univariable analysis, 17 were significant predictors (p < .05) of pediatric heart non-utilization in the multivariable analysis. Low left ventricular ejection fraction (odds ratio (OR)-35.3), hepatitis C positive donor (OR-23.3), high left ventricular ejection fraction (OR-3.29), and hepatitis B positive donor (OR-3.27) were the most significant risk factors. The phDSRI has a C-statistic of 0.80 for the training set and 0.80 for the validation set.
Conclusion:
Using over 8000 donors, the phDSRI uses 17 significant risk factors to predict risk of pediatric heart donor allograft non-utilization.
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