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Transplantation. 2019 Feb 19. doi: 10.1097/TP.0000000000002679. [Epub ahead of print]

A Recipient Risk Prediction Tool for Short Term Mortality after Pediatric Heart Transplantation.

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Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO.



The first year after heart transplantation (HT) has the highest risk of mortality. We aim to derive and validate a recipient risk-prediction tool for early mortality after pediatric HT.


The ISHLT registry was used to identify patients (≤18 years) who underwent primary-HT during 01/2000-12/2014. Independent predictors of 1-year mortality were identified based on recipient characteristics at HT. Risk scores were assigned based on the magnitude of relative odds of 1-year mortality. The predictive capability of the ISHLT registry derived recipient risk score was externally validated using the SRTR registry data from 2015 - 2017 to ensure a cohort of patients completely exclusive from the derivation cohort.


A total of 5045 eligible patients were included in the analysis. The 20-point risk scoring system incorporated 8 recipient variables including age at HT, diagnosis, pre-HT ventilator use, ECMO, inhaled nitric oxide use, infection, estimated glomerular filtration rate, and serum bilirubin. Compared to low-risk score group, high-risk group had sevenfold increased risk of 1-year mortality (HR 7.4 [5.2, 9.1], P<0.001). The C-statistics (0.77) and the Hosmer-Lemeshow goodness-of-fit (0.9) for recipient risk score using derivation cohort from ISHLT registry performed well, and was similar to the internal and external validation cohort (C-statistics 0.75, 0.78 and Hosmer-Lemeshow goodness-of-fit p = 0.4, 0.3 respectively).


This study derived and externally validated a simple risk predictive model based on recipient characteristics at HT that has good prediction characteristics for 1-year post HT mortality. This model may help clinicians identify candidates who are at a higher risk for post-HT mortality and may optimize organ-sharing.

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