O2056: A Novel Index to Predict Time to School Attendance After Pediatric Heart Transplant

Background: In the US, around 500 children undergo pediatric heart transplantation each year. School attendance is associated with increased quality of life in chronically ill pediatric patients and has a profound impact on child development. Research has been done into factors influencing survival in this patient population, but little research has been done into factors influencing other aspects of recovery, such as school attendance post-operatively.

Methods: We conducted univariate and multivariate logistic regression analysis on 5355 pediatric heart transplant recipients using the UNOS database. Continuous variables were compared using the Student’s t-test. Categorical variables were compared using the chi squared test Recipients were split into two age groups, ≤4 year and 5-16 years. The outcome of interest was returning to school at age 6 for ≤4 years, and within 2 years post-transplant for 5-16 years. School attendance after transplant (SAAT scores) were generated via weighting significant variables (p < 0.05) based on odds ratio. High risk and low risk groups for delayed school attendance at the specified endpoints were created by SAAT score stratification. The high-risk included the top 10% of SAAT scores, and the low-risk group included the bottom 10% of SAAT scores.

Results: We found 24 significant factors combined across both cohorts. The most significant protective factors included having a VAD/TAH, age, and transplantation with an ABO incompatible organ (in patients < 2). The most significant risk factors included low-medium functional status, age, and elevated total bilirubin. The indices for each age group had area under the receiver operating curve (AUROC) indicating high predictive value, at 0.82 (≤4 years, 95% CI 0.70-0.74) and 0.72 (5-16 years, 95% CI 0.70-0.74). There was a significant difference in the percentage of high risk (HR) vs low risk (LR) children that attended school at the specified endpoint in both the ≤4 years cohort (HR: 97.95% attendance, LR: 10.16% attendance) and the 5-16 years cohort (HR: 90.46% attendance, LR: 29.31% attendance) (Figure 1 & 2).

Conclusion: This study has the potential to inform perioperative protocols for pediatric heart transplant through identification of modifiable risk factors which could be used as targets for Enhanced Recovery Program components. Additionally, SAAT scores can be used to identify pediatric heart transplant patients at risk for delayed school attendance, allowing for targeted interventions or enhanced follow-up to be used for at-risk children focused on optimizing school attendance.