Pediatric Heart Donor Assessment Tool (PH-DAT): A novel donor risk scoring system to predict 1-year mortality in pediatric heart transplantation
Section snippets
Methods
The UNOS database STAR file was used for this study. The STAR file contains transplant data on all transplants in the USA from October 1987 onward. UNOS is a private, non-profit organization that oversees the Organ Procurement and Transplant Network (OPTN) of the United States and operates in agreement with federal policy. The institutional review board waived full review of this project due to the de-identified nature of the UNOS data set.
Results
A total of 5,732 patients were included in the analysis. Seventy-five percent (4,316) of them were randomized to the derivation cohort and the remainder (1,416) were included in the validation cohort. For all patients, median age was 5 (range 0 to 13) years, 55% (3,156) were male and 59% (3,356) were white. The most common diagnosis was cardiomyopathy, at 49% (2,795). The median estimated eGFR was 83.3 (range 61.5 to 107.8) ml/min/1.73 m2, and 18% (1,036) were on ventilator support before
Discussion
This pediatric-specific donor risk scoring system (the PH-DAT) is a unique tool developed based on 5 donor factors (ischemic time, cerebrovascular accident as the cause of death, donor–recipient height ratio, LVEF, eGFR) that predicted 1-year mortality from a large multi-institutional data set. In addition, this risk score is associated with graft failure out to 5 years post-transplant. Patients transplanted with a donor risk score of ≥16 had a significantly lower 5-year graft survival of 67%
Limitations
This study has both strengths and limitations. We were able to study a nationally representative sample of pediatric heart transplant recipients in the contemporary era. The relatively large sample size allowed for examination of characteristics that are not widely available and thus have been rarely used, if ever, in the analysis of the UNOS database. We only analyzed donor organs that were accepted, and thus further work is needed to determine whether this system has a role in assessing
Disclosure statement
The authors have no conflicts of interest to diclose. We thank Dr. Erin Haynes for her contribution to the manuscript in her role as the chair of the thesis committee for the primary author (F.Z.). This study was presented as a podium presentation at the 36th annual meeting and scientific sessions of the International Society for Heart and Lung Transplantation, April 2016, Washington, DC.
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