A Novel Index to Predict Time to School Attendance After Pediatric Heart Transplant: SAAT Score.

Abstract

School attendance is associated with increased quality of life in chronically ill pediatric patients and has a profound impact on child development[ 1, 2, 3, 4, 5, 6, 7, 8 ]. Despite the importance of school attendance, little research has been done to identify which pediatric transplant recipients are at risk for delayed school attendance due to morbidity. We conducted univariate and multivariate analysis on 5355 pediatric heart transplant recipients using the UNOS database. 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. We found 20 significant factors combined across both cohorts. The most significant protective factors included having a VAD/TAH, age, and transplantation with an ABO incompatible organ. 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 0.81 (≤ 4 years) and 0.72 (5-16 years). In this study, we created SAAT scores to predict time to school attendance in both infants and children with the intention of identifying patients at risk for delayed school attendance who may benefit from targeted interventions including Enhanced Recovery Programs.