BACKGROUND: Pediatric heart transplant (PHT) patients have the highest waitlist mortality of solid organ transplants, yet more than 40% of viable hearts are unutilized. A tool for risk prediction could impact these outcomes. This study aimed to compare and validate the PHT risk score models (RSMs) in the literature. METHODS: The literature was reviewed to identify RSMs published. The United Network for Organ Sharing (UNOS) registry was used to validate the published models identified in a pediatric cohort (<18 years) transplanted between 2017 and 2019 and compared against the Scientific Registry of Transplant Recipients (SRTR) 2021 model. Primary outcome was post-transplant 1-year mortality. Odds ratios were obtained to evaluate the association between risk score groups and 1-year mortality. Area under the curve (AUC) was used to compare the RSM scores on their goodness-of-fit, using Delong's test. RESULTS: Six recipient and one donor RSMs published between 2008 and 2021 were included in the analysis. The validation cohort included 1,003 PHT. Low-risk groups had a significantly better survival than high-risk groups as predicted by Choudhry (OR = 4.59, 95% CI [2.36-8.93]) and Fraser III (3.17 [1.43-7.05]) models. Choudhry's and SRTR models achieved the best overall performance (AUC = 0.69 and 0.68, respectively). When adjusted for CHD and ventricular assist device support, all models reported better predictability [AUC > 0.6]. Choudhry (AUC = 0.69) and SRTR (AUC = 0.71) remained the best predicting RSMs even after adjustment. CONCLUSION: Although the RSMs by SRTR and Choudhry provided the best prediction for 1-year mortality, none demonstrated a strong (AUC ≥ 0.8) concordance statistic. All published studies lacked advanced analytical approaches and were derived from an inherently limited dataset.
BACKGROUND: Pediatric heart transplant (PHT) patients have the highest waitlist mortality of solid organ transplants, yet more than 40% of viable hearts are unutilized. A tool for risk prediction could impact these outcomes. This study aimed to compare and validate the PHT risk score models (RSMs) in the literature. METHODS: The literature was reviewed to identify RSMs published. The United Network for Organ Sharing (UNOS) registry was used to validate the published models identified in a pediatric cohort (<18 years) transplanted between 2017 and 2019 and compared against the Scientific Registry of Transplant Recipients (SRTR) 2021 model. Primary outcome was post-transplant 1-year mortality. Odds ratios were obtained to evaluate the association between risk score groups and 1-year mortality. Area under the curve (AUC) was used to compare the RSM scores on their goodness-of-fit, using Delong's test. RESULTS: Six recipient and one donor RSMs published between 2008 and 2021 were included in the analysis. The validation cohort included 1,003 PHT. Low-risk groups had a significantly better survival than high-risk groups as predicted by Choudhry (OR = 4.59, 95% CI [2.36-8.93]) and Fraser III (3.17 [1.43-7.05]) models. Choudhry's and SRTR models achieved the best overall performance (AUC = 0.69 and 0.68, respectively). When adjusted for CHD and ventricular assist device support, all models reported better predictability [AUC > 0.6]. Choudhry (AUC = 0.69) and SRTR (AUC = 0.71) remained the best predicting RSMs even after adjustment. CONCLUSION: Although the RSMs by SRTR and Choudhry provided the best prediction for 1-year mortality, none demonstrated a strong (AUC ≥ 0.8) concordance statistic. All published studies lacked advanced analytical approaches and were derived from an inherently limited dataset.
Authors: Swati Choudhry; Yunfei Wang; Susan W Denfield; Antonio G Cabrera; Jack F Price; Hari P Tunuguntla; Vikas R Dharnidharka; Charles E Canter; William J Dreyer Journal: Transplantation Date: 2019-11 Impact factor: 4.939
Authors: Kyle W Riggs; Benjamin J Kroslowitz; Clifford Chin; Farhan Zafar; David L S Morales Journal: Ann Thorac Surg Date: 2019-11-14 Impact factor: 4.330
Authors: Farhan Zafar; Robert D Jaquiss; Christopher S Almond; Angela Lorts; Clifford Chin; Raheel Rizwan; Roosevelt Bryant; James S Tweddell; David L S Morales Journal: J Heart Lung Transplant Date: 2017-03-07 Impact factor: 10.247
Authors: Charles D Fraser; Joshua C Grimm; Xun Zhou; Cecillia Lui; Kate Giuliano; Alejandro Suarez-Pierre; Todd C Crawford; J Trent Magruder; Narutoshi Hibino; Luca A Vricella Journal: World J Pediatr Congenit Heart Surg Date: 2019-05
Authors: Joshua C Grimm; Ashish S Shah; J Trent Magruder; Arman Kilic; Vicente Valero; Samuel P Dungan; Ryan J Tedford; Stuart D Russell; Glenn J R Whitman; Christopher M Sciortino Journal: Ann Thorac Surg Date: 2015-09-19 Impact factor: 4.330
Authors: Jon J Snyder; Nicholas Salkowski; S Joseph Kim; David Zaun; Hui Xiong; Ajay K Israni; Bertram L Kasiske Journal: Transplantation Date: 2016-02 Impact factor: 4.939