A Novel Risk Index to Predict Waiting Times for Pediatric Heart Transplant Candidates

Purpose: Heart transplantation is the definitive treatment for many pediatric patients with cardiac conditions. However, significant variability exists in waitlist durations, influenced by multiple factors that remain poorly understood. This lack of research hampers the development of standardized methods to predict and transparently communicate wait times to patients and families. Methods: This study aimed to create an index to predict pediatric heart transplant waitlist durations using data from 7,856 patients in the Organ Procurement and Transplantation Network (OPTN) database. Significant variables associated with waitlist times were identified through univariate and multivariable Cox regression analyses (p < 0.05), incorporated into a risk index with points assigned according to multivariable odds ratios, and evaluated for predictive accuracy using receiver operating characteristic (ROC) curve analysis. Results: Our study identified 8 factors from multivariable analysis to significantly impact pediatric heart transplant waitlist durations. After utilizing these factors to create the risk index, ROC analysis to evaluate the predictive capabilities of the index resulted in a c-statistic of 0.81 (95% Confidence Interval: 0.801-0.835). Conclusion: Our findings highlight key determinants of waitlist times and demonstrate the potential of a predictive index to improve transparency, guide clinical decision-making, and manage patient and family expectations.