Validation of a Simple Score to Determine Risk of Early Rejection After Pediatric Heart Transplantation

Ryan J. Butts, Andrew J. Savage, Andrew M. Atz, Elisabeth M. Heal, Ali L. Burnette, Minoo M. Kavarana, Scott M. Bradley, Shahryar M. Chowdhury

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objectives: This study aimed to develop a reliable and feasible score to assess the risk of rejection in pediatric heart transplantation recipients during the first post-transplant year. Background: The first post-transplant year is the most likely time for rejection to occur in pediatric heart transplantation. Rejection during this period is associated with worse outcomes. Methods: The United Network for Organ Sharing database was queried for pediatric patients (age <18 years) who underwent isolated orthotopic heart transplantation from January 1, 2000 to December 31, 2012. Transplantations were divided into a derivation cohort (n = 2,686) and a validation (n = 509) cohort. The validation cohort was randomly selected from 20% of transplantations from 2005 to 2012. Covariates found to be associated with rejection (p < 0.2) were included in the initial multivariable logistic regression model. The final model was derived by including only variables independently associated with rejection. A risk score was then developed using relative magnitudes of the covariates' odds ratio. The score was then tested in the validation cohort. Results: A 9-point risk score using 3 variables (age, cardiac diagnosis, and panel reactive antibody) was developed. Mean score in the derivation and validation cohorts were 4.5 ± 2.6 and 4.8 ± 2.7, respectively. A higher score was associated with an increased rate of rejection (score = 0, 10.6% in the validation cohort vs. score = 9, 40%; p < 0.01). In weighted regression analysis, the model-predicted risk of rejection correlated closely with the actual rates of rejection in the validation cohort (R2 = 0.86; p < 0.01). Conclusions: The rejection score is accurate in determining the risk of early rejection in pediatric heart transplantation recipients. The score has the potential to be used in clinical practice to aid in determining the immunosuppressant regimen and the frequency of rejection surveillance in the first post-transplant year.

Original languageEnglish (US)
Pages (from-to)670-676
Number of pages7
JournalJACC: Heart Failure
Issue number9
StatePublished - Sep 1 2015

Bibliographical note

Funding Information:
This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C . The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. Data represented is based on OPTN data as of December 31, 2013. Dr. Heal was supported by National Institutes of Health/National Heart, Lung, and Blood Institute Grant 5T32-HL07710-19.

Publisher Copyright:
© 2015 American College of Cardiology Foundation.


  • Heart transplant
  • Pediatrics
  • Rejection


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