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Pediatric Heart Donor Assessment Tool (PH-DAT): A novel donor risk scoring system to predict 1-year mortality in pediatric heart transplantation
- Source :
- The Journal of Heart and Lung Transplantation. 37:332-339
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- In this study we sought to quantify hazards associated with various donor factors into a cumulative risk scoring system (the Pediatric Heart Donor Assessment Tool, or PH-DAT) to predict 1-year mortality after pediatric heart transplantation (PHT).PHT data with complete donor information (5,732) were randomly divided into a derivation cohort and a validation cohort (3:1). From the derivation cohort, donor-specific variables associated with 1-year mortality (exploratory p-value0.2) were incorporated into a multivariate logistic regression model. Scores were assigned to independent predictors (p0.05) based on relative odds ratios (ORs).The final model had an acceptable predictive value (c-statistic = 0.62). The significant 5 variables (ischemic time, stroke as the cause of death, donor-to-recipient height ratio, donor left ventricular ejection fraction, glomerular filtration rate) were used for the scoring system. The validation cohort demonstrated a strong correlation between the observed and expected rates of 1-year mortality (r = 0.87). The risk of 1-year mortality increases by 11% (OR 1.11 [1.08 to 1.14]; p0.001) in the derivation cohort and 9% (OR 1.09 [1.04 to 1.14]; p = 0.001) in the validation cohort with an increase of 1-point in score. Mortality risk increased 5 times from the lowest to the highest donor score in this cohort. Based on this model, a donor score range of 10 to 28 predicted 1-year recipient mortality of 11% to 31%.This novel pediatric-specific, donor risk scoring system appears capable of predicting post-transplant mortality. Although the PH-DAT may benefit organ allocation and assessment of recipient risk while controlling for donor risk, prospective validation of this model is warranted.
- Subjects :
- Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Time Factors
Scoring system
Adolescent
Renal function
030204 cardiovascular system & hematology
030230 surgery
Risk Assessment
Donor Selection
Cohort Studies
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Internal medicine
medicine
Humans
Child
Stroke
Cause of death
Transplantation
Ejection fraction
business.industry
Infant
Prognosis
medicine.disease
Surgery
Child, Preschool
Cohort
Heart Transplantation
Female
Pediatric heart transplantation
Heart donor
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 10532498
- Volume :
- 37
- Database :
- OpenAIRE
- Journal :
- The Journal of Heart and Lung Transplantation
- Accession number :
- edsair.doi.dedup.....0bf5d3f0f219db161a9a570817e5ff91