Validation of a Simple Score to Determine Risk of Early Rejection After Pediatric Heart Transplantation
Abstract 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 hea...
Gespeichert in:
| Veröffentlicht in: | JACC. Heart failure 2015-09, Vol.3 (9), p.670-676 |
|---|---|
| Hauptverfasser: | , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 676 |
|---|---|
| container_issue | 9 |
| container_start_page | 670 |
| container_title | JACC. Heart failure |
| container_volume | 3 |
| creator | Butts, Ryan J., MD Savage, Andrew J., MD, MSCR Atz, Andrew M., MD Heal, Elisabeth M., DO Burnette, Ali L., FNP Kavarana, Minoo M., MD Bradley, Scott M., MD Chowdhury, Shahryar M., MD, MSCR |
| description | Abstract 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 |
| doi_str_mv | 10.1016/j.jchf.2015.04.014 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4631313</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S2213177915003431</els_id><sourcerecordid>1711539872</sourcerecordid><originalsourceid>FETCH-LOGICAL-c510t-309e1b7b44fe286d1fda44da97810957a2b25c84a2ad49039a537205bf9028ac3</originalsourceid><addsrcrecordid>eNp9UsFu1DAQjRCIVqU_wAH5yGWDx7ETR0KVqlIoUiVQt3C1Js6EdZqNFztbaf-Gb-HLcLplBRywD7bk955n3pssewk8Bw7lmz7v7arLBQeVc5lzkE-yYyGgWEClq6eHe1UfZacx9jwtrUBr_Tw7EmVRCinVcbb6ioNrcXJ-ZL5jyJZuvRmILa0PxCbP3tFEYe1G-vnjxsW7GXSJYdixG-rJPvDOuwRhn6l1OAVn2RVhmNhtwDFuBhynB_UX2bMOh0inj-dJ9uX95e3F1eL604ePF-fXC6uAT4uC1wRN1UjZkdBlC12LUrZYVxp4rSoUjVBWSxTYypoXNaqiElw1Xc2FRlucZGd73c22WVNraZwCDmYT3BrDznh05u-X0a3MN39vZFlA2kng9aNA8N-3FCezdtHSkDohv40GKgBV1LoSCSr2UBt8jIG6wzfAzZyS6c2ckplTMlyalFIivfqzwAPldyYJ8HYPoGTTvaNgonU02uRvSI6b1rv_65_9Q7eDG53F4Y52FHu_DWMKwICJwnCznOdkHhNQnBcyOfALKWW5rA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1711539872</pqid></control><display><type>article</type><title>Validation of a Simple Score to Determine Risk of Early Rejection After Pediatric Heart Transplantation</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Butts, Ryan J., MD ; Savage, Andrew J., MD, MSCR ; Atz, Andrew M., MD ; Heal, Elisabeth M., DO ; Burnette, Ali L., FNP ; Kavarana, Minoo M., MD ; Bradley, Scott M., MD ; Chowdhury, Shahryar M., MD, MSCR</creator><creatorcontrib>Butts, Ryan J., MD ; Savage, Andrew J., MD, MSCR ; Atz, Andrew M., MD ; Heal, Elisabeth M., DO ; Burnette, Ali L., FNP ; Kavarana, Minoo M., MD ; Bradley, Scott M., MD ; Chowdhury, Shahryar M., MD, MSCR</creatorcontrib><description>Abstract 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.</description><identifier>ISSN: 2213-1779</identifier><identifier>EISSN: 2213-1787</identifier><identifier>DOI: 10.1016/j.jchf.2015.04.014</identifier><identifier>PMID: 26362445</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Biopsy ; Cardiovascular ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Graft Rejection - diagnosis ; Graft Rejection - epidemiology ; heart transplant ; Heart Transplantation ; Humans ; Incidence ; Infant ; Male ; Myocardium - pathology ; pediatrics ; Postoperative Period ; rejection ; Reproducibility of Results ; Retrospective Studies ; Risk Assessment - methods ; United States - epidemiology</subject><ispartof>JACC. Heart failure, 2015-09, Vol.3 (9), p.670-676</ispartof><rights>American College of Cardiology Foundation</rights><rights>2015 American College of Cardiology Foundation</rights><rights>Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c510t-309e1b7b44fe286d1fda44da97810957a2b25c84a2ad49039a537205bf9028ac3</citedby><cites>FETCH-LOGICAL-c510t-309e1b7b44fe286d1fda44da97810957a2b25c84a2ad49039a537205bf9028ac3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26362445$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Butts, Ryan J., MD</creatorcontrib><creatorcontrib>Savage, Andrew J., MD, MSCR</creatorcontrib><creatorcontrib>Atz, Andrew M., MD</creatorcontrib><creatorcontrib>Heal, Elisabeth M., DO</creatorcontrib><creatorcontrib>Burnette, Ali L., FNP</creatorcontrib><creatorcontrib>Kavarana, Minoo M., MD</creatorcontrib><creatorcontrib>Bradley, Scott M., MD</creatorcontrib><creatorcontrib>Chowdhury, Shahryar M., MD, MSCR</creatorcontrib><title>Validation of a Simple Score to Determine Risk of Early Rejection After Pediatric Heart Transplantation</title><title>JACC. Heart failure</title><addtitle>JACC Heart Fail</addtitle><description>Abstract 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.</description><subject>Adolescent</subject><subject>Biopsy</subject><subject>Cardiovascular</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Graft Rejection - diagnosis</subject><subject>Graft Rejection - epidemiology</subject><subject>heart transplant</subject><subject>Heart Transplantation</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infant</subject><subject>Male</subject><subject>Myocardium - pathology</subject><subject>pediatrics</subject><subject>Postoperative Period</subject><subject>rejection</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Risk Assessment - methods</subject><subject>United States - epidemiology</subject><issn>2213-1779</issn><issn>2213-1787</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UsFu1DAQjRCIVqU_wAH5yGWDx7ETR0KVqlIoUiVQt3C1Js6EdZqNFztbaf-Gb-HLcLplBRywD7bk955n3pssewk8Bw7lmz7v7arLBQeVc5lzkE-yYyGgWEClq6eHe1UfZacx9jwtrUBr_Tw7EmVRCinVcbb6ioNrcXJ-ZL5jyJZuvRmILa0PxCbP3tFEYe1G-vnjxsW7GXSJYdixG-rJPvDOuwRhn6l1OAVn2RVhmNhtwDFuBhynB_UX2bMOh0inj-dJ9uX95e3F1eL604ePF-fXC6uAT4uC1wRN1UjZkdBlC12LUrZYVxp4rSoUjVBWSxTYypoXNaqiElw1Xc2FRlucZGd73c22WVNraZwCDmYT3BrDznh05u-X0a3MN39vZFlA2kng9aNA8N-3FCezdtHSkDohv40GKgBV1LoSCSr2UBt8jIG6wzfAzZyS6c2ckplTMlyalFIivfqzwAPldyYJ8HYPoGTTvaNgonU02uRvSI6b1rv_65_9Q7eDG53F4Y52FHu_DWMKwICJwnCznOdkHhNQnBcyOfALKWW5rA</recordid><startdate>20150901</startdate><enddate>20150901</enddate><creator>Butts, Ryan J., MD</creator><creator>Savage, Andrew J., MD, MSCR</creator><creator>Atz, Andrew M., MD</creator><creator>Heal, Elisabeth M., DO</creator><creator>Burnette, Ali L., FNP</creator><creator>Kavarana, Minoo M., MD</creator><creator>Bradley, Scott M., MD</creator><creator>Chowdhury, Shahryar M., MD, MSCR</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20150901</creationdate><title>Validation of a Simple Score to Determine Risk of Early Rejection After Pediatric Heart Transplantation</title><author>Butts, Ryan J., MD ; Savage, Andrew J., MD, MSCR ; Atz, Andrew M., MD ; Heal, Elisabeth M., DO ; Burnette, Ali L., FNP ; Kavarana, Minoo M., MD ; Bradley, Scott M., MD ; Chowdhury, Shahryar M., MD, MSCR</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c510t-309e1b7b44fe286d1fda44da97810957a2b25c84a2ad49039a537205bf9028ac3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>Biopsy</topic><topic>Cardiovascular</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Graft Rejection - diagnosis</topic><topic>Graft Rejection - epidemiology</topic><topic>heart transplant</topic><topic>Heart Transplantation</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infant</topic><topic>Male</topic><topic>Myocardium - pathology</topic><topic>pediatrics</topic><topic>Postoperative Period</topic><topic>rejection</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Risk Assessment - methods</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Butts, Ryan J., MD</creatorcontrib><creatorcontrib>Savage, Andrew J., MD, MSCR</creatorcontrib><creatorcontrib>Atz, Andrew M., MD</creatorcontrib><creatorcontrib>Heal, Elisabeth M., DO</creatorcontrib><creatorcontrib>Burnette, Ali L., FNP</creatorcontrib><creatorcontrib>Kavarana, Minoo M., MD</creatorcontrib><creatorcontrib>Bradley, Scott M., MD</creatorcontrib><creatorcontrib>Chowdhury, Shahryar M., MD, MSCR</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JACC. Heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Butts, Ryan J., MD</au><au>Savage, Andrew J., MD, MSCR</au><au>Atz, Andrew M., MD</au><au>Heal, Elisabeth M., DO</au><au>Burnette, Ali L., FNP</au><au>Kavarana, Minoo M., MD</au><au>Bradley, Scott M., MD</au><au>Chowdhury, Shahryar M., MD, MSCR</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Validation of a Simple Score to Determine Risk of Early Rejection After Pediatric Heart Transplantation</atitle><jtitle>JACC. Heart failure</jtitle><addtitle>JACC Heart Fail</addtitle><date>2015-09-01</date><risdate>2015</risdate><volume>3</volume><issue>9</issue><spage>670</spage><epage>676</epage><pages>670-676</pages><issn>2213-1779</issn><eissn>2213-1787</eissn><abstract>Abstract 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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26362445</pmid><doi>10.1016/j.jchf.2015.04.014</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2213-1779 |
| ispartof | JACC. Heart failure, 2015-09, Vol.3 (9), p.670-676 |
| issn | 2213-1779 2213-1787 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4631313 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adolescent Biopsy Cardiovascular Child Child, Preschool Female Follow-Up Studies Graft Rejection - diagnosis Graft Rejection - epidemiology heart transplant Heart Transplantation Humans Incidence Infant Male Myocardium - pathology pediatrics Postoperative Period rejection Reproducibility of Results Retrospective Studies Risk Assessment - methods United States - epidemiology |
| title | Validation of a Simple Score to Determine Risk of Early Rejection After Pediatric Heart Transplantation |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-03T04%3A31%3A55IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Validation%20of%20a%20Simple%20Score%20to%20Determine%C2%A0Risk%20of%20Early%20Rejection%20After%20Pediatric%20Heart%20Transplantation&rft.jtitle=JACC.%20Heart%20failure&rft.au=Butts,%20Ryan%20J.,%20MD&rft.date=2015-09-01&rft.volume=3&rft.issue=9&rft.spage=670&rft.epage=676&rft.pages=670-676&rft.issn=2213-1779&rft.eissn=2213-1787&rft_id=info:doi/10.1016/j.jchf.2015.04.014&rft_dat=%3Cproquest_pubme%3E1711539872%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1711539872&rft_id=info:pmid/26362445&rft_els_id=S2213177915003431&rfr_iscdi=true |