Risk Index Predicts Pediatric Heart Allograft Non-Utilization.

Autor: Lynn J; Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA., Malik T; Department of Internal Medicine, New York University, New York City, New York, USA., Montgomery A; Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA., Lang A; Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA., Shamapant N; Department of Internal Medicine, University of Colorado, Denver, Colorado, USA., Miggins J; Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA., Kamepalli S; Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA., Goss J; Division of Abdominal Transplant, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA., Rana A; Division of Abdominal Transplant, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Jazyk: angličtina
Zdroj: Pediatric transplantation [Pediatr Transplant] 2024 Feb; Vol. 28 (1), pp. e14629.
DOI: 10.1111/petr.14629
Abstrakt: 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.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
Externí odkaz: