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Risk Scoring Tool Based on Donor Characteristics in Pediatric Heart Transplantation and its Impact on Patient Survival

Zafar, Farhan
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1470753184

Abstract Details

2016, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Heart failure accounts for 14000 pediatric hospital admissions each year in the US. Heart transplant remains the best long-term treatment option for children with end-stage heart failure; however, a persistent national organ donor shortage limits the availability of pediatric HTx and results in longer waiting list times and increased waiting list mortality. On the contrary, around 60% of donor hearts are discarded. There is significant variability in donor acceptance practices among transplant centers and many of these organs are discarded due to criteria that are determined by individual institutions and are not evidence based. This study sought to quantify hazards associated with various donor factors into a cumulative risk scoring system to predict 1-year mortality after pediatric heart transplantation (PHT). This score will standardize the donor acceptance practices and will positively impact donor utilization. Prospectively collected United Network of Organ Sharing (UNOS) data of all PHT between 1994-2014 was examined to identify all PHT with complete donor information. Cohort was randomly divided into derivation and validation cohort in a 3:1 fashion; one was used for derivation of cumulative scores and other for external validation of the scores. From the derivation cohort donor specific variables associated with 1-year mortality (exploratory p-value <0.2) were incorporated into a multivariate logistic regression model. The final model was designed by forward entry method conditional on improvement in explanatory power. Scores were assigned to independent predictors (p <0.05) based on relative odds ratios. A total of 5732 PHT were divided into derivation (4316) and validation (1416) cohorts. The final model had an acceptable predictive value (c = 0.62). The significant five variables were used to form a 31-point scoring system. The validation cohort demonstrated a strong correlation between the observed and expected rates of 1-year mortality (r = 0.87). With every 1-point increase in the score, risk of 1-year mortality increases by 11% [OR 1.11 (1.08 - 1.14); p<0.001] in the derivation cohort and 9% [OR 1.09 (1.04 - 1.14); p=0.001] in the validation cohort. 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 a 1-year recipient mortality of up to 31%. This novel pediatric-specific, donor-risk scoring system predicts post-transplant mortality. This tool will be valuable for organ allocation and in examining recipient risk while controlling for donor risk.
Erin Nicole Haynes (Committee Chair)
Robert Douglas Benjamin Jaquiss (Committee Member)
David Luis Simon Morales (Committee Member)
32 p.
Health Sciences
Pediatric heart transplant; donor risk

Recommended Citations

Citations

  • Zafar, F. (2016). Risk Scoring Tool Based on Donor Characteristics in Pediatric Heart Transplantation and its Impact on Patient Survival [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1470753184

    APA Style (7th edition)

  • Zafar, Farhan. Risk Scoring Tool Based on Donor Characteristics in Pediatric Heart Transplantation and its Impact on Patient Survival. 2016. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1470753184.

    MLA Style (8th edition)

  • Zafar, Farhan. "Risk Scoring Tool Based on Donor Characteristics in Pediatric Heart Transplantation and its Impact on Patient Survival." Master's thesis, University of Cincinnati, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1470753184

    Chicago Manual of Style (17th edition)

ucin1470753184
218
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This open access ETD is published by University of Cincinnati and OhioLINK.