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. 2024 Feb;28(1):e14629.
doi: 10.1111/petr.14629.

Risk Index Predicts Pediatric Heart Allograft Non-Utilization

Jake Lynn  1 , Tahir Malik  2 , Ashley Montgomery  1 , Anna Lang  1 , Nikhil Shamapant  3 , John Miggins  1 , Spoorthi Kamepalli  1 , John Goss  4 , Abbas Rana  4
Affiliations

Risk Index Predicts Pediatric Heart Allograft Non-Utilization

Jake Lynn et al. Pediatr Transplant. 2024 Feb.

Abstract

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.

Keywords: allograft non-utilization; pediatric heart transplantation; pediatric non-utilization risk index.

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References

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