TY - JOUR
T1 - Cumulative Effect of Preoperative Risk Factors on Mortality After Pediatric Heart Transplantation
AU - O'Connor, Matthew J.
AU - Glatz, Andrew C.
AU - Rossano, Joseph W.
AU - Shaddy, Robert E.
AU - Ryan, Rachel
AU - Ravishankar, Chitra
AU - Fuller, Stephanie
AU - Mascio, Christopher E.
AU - Gaynor, J. William
AU - Lin, Kimberly Y.
N1 - Funding Information:
In the adult HT literature, the Index for Mortality Prediction after Cardiac Transplantation score is a 50-point score consisting of 12 clinical variables and predicted 1-year post-HT mortality in both the UNOS and International Society for Heart and Lung Transplantation cohorts. In this model, the presence of CHD was one of the factors most closely associated with mortality, second only to the presence of temporary circulatory support at HT [15]. This model, subsequently validated in the pediatric population [16], also supports the concept of cumulative risk, with higher risk scores closely associated with increased 1-year mortality post-HT; however, granularity pertaining to specific diagnoses remains limited in this model.
Funding Information:
In the adult HT literature, the Index for Mortality Prediction after Cardiac Transplantation score is a 50-point score consisting of 12 clinical variables and predicted 1-year post-HT mortality in both the UNOS and International Society for Heart and Lung Transplantation cohorts [15, 16]. In this model, the presence of CHD was one of the factors most closely associated with mortality, second only to the presence of temporary circulatory support at HT [15]. This model, subsequently validated in the pediatric population [16], also supports the concept of cumulative risk, with higher risk scores closely associated with increased 1-year mortality post-HT; however, granularity pertaining to specific diagnoses remains limited in this model.
Publisher Copyright:
© 2018 The Society of Thoracic Surgeons
PY - 2018/8
Y1 - 2018/8
N2 - Background: Risk assessment in heart transplantation is critical for candidate selection, but current models inadequately assess individual risk of postoperative mortality. We sought to identify risk factors and develop a scoring system to predict mortality after heart transplantation in children. Methods: The records of patients undergoing heart transplantation at our institution from 2010 through 2016 were reviewed. Clinical characteristics were recorded and compared between survivors and nonsurvivors. We used Cox proportional hazard modeling of factors associated with postoperative mortality to develop a risk factor score. Results: There were 74 patients who underwent heart transplantation at a mean age of 8.8 ± 6.6 years. Congenital heart disease was the most common indication, comprising 48.6% of the cohort. Overall mortality was 18.9%, with 10 of 14 dying within 30 days of the operation or during the initial postoperative admission (early mortality). Preoperative factors associated with overall mortality were single-ventricle congenital heart disease (hazard ratio [HR], 3.2; p = 0.042), biventricular assist device (HR, 4.8; p = 0.043), history of four or more sternotomies (HR, 3.9; p = 0.023), panel reactive antibody exceeding 10% (HR, 4.4; p = 0.013), any previous operation at another institution (HR, 3.2; p = 0.038), and pulmonary vein disease (HR, 4.7; p = 0.045). Each risk factor was assigned a point value, based on similar magnitude of the HRs. A score of 4 or higher predicted mortality with 57% sensitivity and 90% specificity. Conclusions: In this single-center pediatric cohort, postheart transplantation mortality could be predicted using patient-specific risk factors. The cumulative effect of these risk factors predicted mortality with high specificity.
AB - Background: Risk assessment in heart transplantation is critical for candidate selection, but current models inadequately assess individual risk of postoperative mortality. We sought to identify risk factors and develop a scoring system to predict mortality after heart transplantation in children. Methods: The records of patients undergoing heart transplantation at our institution from 2010 through 2016 were reviewed. Clinical characteristics were recorded and compared between survivors and nonsurvivors. We used Cox proportional hazard modeling of factors associated with postoperative mortality to develop a risk factor score. Results: There were 74 patients who underwent heart transplantation at a mean age of 8.8 ± 6.6 years. Congenital heart disease was the most common indication, comprising 48.6% of the cohort. Overall mortality was 18.9%, with 10 of 14 dying within 30 days of the operation or during the initial postoperative admission (early mortality). Preoperative factors associated with overall mortality were single-ventricle congenital heart disease (hazard ratio [HR], 3.2; p = 0.042), biventricular assist device (HR, 4.8; p = 0.043), history of four or more sternotomies (HR, 3.9; p = 0.023), panel reactive antibody exceeding 10% (HR, 4.4; p = 0.013), any previous operation at another institution (HR, 3.2; p = 0.038), and pulmonary vein disease (HR, 4.7; p = 0.045). Each risk factor was assigned a point value, based on similar magnitude of the HRs. A score of 4 or higher predicted mortality with 57% sensitivity and 90% specificity. Conclusions: In this single-center pediatric cohort, postheart transplantation mortality could be predicted using patient-specific risk factors. The cumulative effect of these risk factors predicted mortality with high specificity.
UR - http://www.scopus.com/inward/record.url?scp=85049335963&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2018.03.044
DO - 10.1016/j.athoracsur.2018.03.044
M3 - Article
C2 - 29684375
AN - SCOPUS:85049335963
SN - 0003-4975
VL - 106
SP - 561
EP - 566
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -