Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO.
Transplantation. 2019 Nov;103(11):2434-2439. doi: 10.1097/TP.0000000000002679.
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 International Society for Heart and Lung Transplantation (ISHLT) registry was used to identify patients (≤18 y) who underwent primary HT during January 2000-December 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 Scientific Registry of Transplant Recipients registry data from 2015 to 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, extracorporeal membrane oxygenation, inhaled nitric oxide use, infection, estimated glomerular filtration rate, and serum bilirubin. Compared with low-risk score group, high-risk group had 7-fold increased risk of 1-year mortality (hazard ratio 7.4; 95% CI [5.2-9.1]; P < 0.001). The C-statistics (0.77) and 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.
心脏移植（HT）后第一年的死亡率最高。我们旨在为儿科 HT 后的早期死亡率建立并验证一种受者风险预测工具。
使用国际心肺移植学会（ISHLT）注册中心，识别 2000 年 1 月至 2014 年 12 月期间接受原发性 HT 的患者（≤18 岁）。根据 HT 时受者的特征确定 1 年死亡率的独立预测因素。根据 1 年死亡率的相对风险幅度分配风险评分。使用 2015 年至 2017 年的 Scientific Registry of Transplant Recipients 登记数据对 ISHLT 登记处衍生的受者风险评分进行外部验证，以确保患者队列完全排除在推导队列之外。
共纳入 5045 例符合条件的患者。该 20 分风险评分系统纳入了 8 个受者变量，包括 HT 时的年龄、诊断、HT 前使用呼吸机、体外膜氧合、吸入一氧化氮、感染、估计肾小球滤过率和血清胆红素。与低危评分组相比，高危评分组 1 年死亡率的风险增加了 7 倍（危险比 7.4；95%置信区间 [5.2-9.1]；P <0.001）。ISHLT 登记处的推导队列中使用受者风险评分的 C 统计量（0.77）和 Hosmer-Lemeshow 拟合优度（0.9）表现良好，与内部和外部验证队列相似（C 统计量 0.75、0.78，Hosmer-Lemeshow 拟合优度 P=0.4、0.3）。
本研究基于 HT 时受者特征建立并外部验证了一种简单的风险预测模型，该模型对 HT 后 1 年死亡率具有良好的预测特征。该模型可帮助临床医生识别 HT 后死亡率较高的候选者，并可能优化器官共享。
