title: Pediatric Heart Donor Assessment Tool (PH-DAT): A novel donor risk scoring system to predict 1-year mortality in pediatric heart transplantation.
abstract: In this study we sought to quantify hazards associated with various donor factors into a cumulative risk scoring system (the Pediatric Heart Donor Assessment Tool, or PH-DAT) to predict 1-year mortality after pediatric heart transplantation (PHT).
  
  
  
  PHT data with complete donor information (5,732) were randomly divided into a derivation cohort and a validation cohort (3:1). From the derivation cohort, donor-specific variables associated with 1-year mortality (exploratory p-value < 0.2) were incorporated into a multivariate logistic regression model. Scores were assigned to independent predictors (p < 0.05) based on relative odds ratios (ORs).
  
  
  
  The final model had an acceptable predictive value (c-statistic = 0.62). The significant 5 variables (ischemic time, stroke as the cause of death, donor-to-recipient height ratio, donor left ventricular ejection fraction, glomerular filtration rate) were used for the scoring system. The validation cohort demonstrated a strong correlation between the observed and expected rates of 1-year mortality (r = 0.87). The risk of 1-year mortality increases by 11% (OR 1.11 [1.08 to 1.14]; p < 0.001) in the derivation cohort and 9% (OR 1.09 [1.04 to 1.14]; p = 0.001) in the validation cohort with an increase of 1-point in score. Mortality risk increased 5 times from the lowest to the highest donor score in this cohort. Based on this model, a donor score range of 10 to 28 predicted 1-year recipient mortality of 11% to 31%.
  
  
  
  This novel pediatric-specific, donor risk scoring system appears capable of predicting post-transplant mortality. Although the PH-DAT may benefit organ allocation and assessment of recipient risk while controlling for donor risk, prospective validation of this model is warranted.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. Electronic address: farhan.zafar@cchmc.org.
authors.forename: Farhan
authors.initials: F
authors.lastname: Zafar
authors.affiliation: Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Jaquiss
authors.affiliation: Stanford University School of Medicine, San Francisco, California, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Almond
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Lorts
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Clifford
authors.initials: C
authors.lastname: Chin
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Raheel
authors.initials: R
authors.lastname: Rizwan
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Roosevelt
authors.initials: R
authors.lastname: Bryant
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Tweddell
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: David L S
authors.initials: DLS
authors.lastname: Morales
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D046148:Donor Selection / Q000379:methods*; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D018570:Risk Assessment; D013997:Time Factors
keywords: PH-DAT; donor assessment tool; donor factors; donor risk score; one-year mortality; pediatric heart transplant