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Outcome of shared care for pediatric cardiac transplantation between two nations with different health care systems
Jacob Simmonds1, Hellene Murchan2, Adam James2
1Department of Paediatric Cardiology, Great Ormond Street National Health Service Trust, London, United Kingdom.
Insights
Shared care for pediatric cardiac transplantation between Ireland and the UK shows comparable outcomes for rejection, coronary vasculopathy, and survival. This international collaboration demonstrates successful outcomes for young heart transplant recipients.
Area of Science:
- Pediatric Cardiology
- Transplantation Medicine
- Immunology
Background:
- Limited data exists on pediatric cardiac transplantation outcomes within international shared care programs.
- Children undergoing heart transplantation have complex immunological, cardiac, and psychological needs.
- Investigating shared care models is crucial for optimizing care for these young patients.
Purpose of the Study:
- To evaluate the outcomes of a shared care cardiac transplantation program between two countries.
- To assess the feasibility and effectiveness of cross-border collaboration in pediatric heart transplantation.
- To compare outcomes between a referral center and a specialist transplant center.
Main Methods:
- A retrospective analysis of pediatric patients undergoing cardiac transplantation between 1990 and 2013.
- Collaboration between a center in the Republic of Ireland and two centers in the United Kingdom.
- Monitoring of rejection episodes, coronary vasculopathy, survival rates, and follow-up care.
Main Results:
- Twenty-two patients underwent 23 cardiac transplants, with a median age of 3.2 years at transplant.
- The referral center managed 4 out of 5 late rejection episodes.
- Outcomes regarding rejection, coronary vasculopathy, and survival were comparable between the referral and transplant centers.
Conclusions:
- Shared care for pediatric heart transplant patients between two nations yielded favorable results.
- Outcomes in the shared care model were comparable to those at the specialist transplant center.
- These findings support the liberalization of follow-up care models in similar international transplant programs.
Background:
No data are available for the outcome of children undergoing cardiac transplantation with shared care programs in different countries. We sought to investigate the outcome of a shared care transplant program between 2 countries given the complex immunologic, cardiac, and psychologic needs of these young people.
Methods:
We investigated the results of a shared care program for children who underwent cardiac transplantation between our center in the Republic of Ireland and 2 centers in the United Kingdom over 2 decades.
Results:
Between 1990 and 2013, 22 patients underwent 23 cardiac transplants. The median age at transplant was 3.2 years (range, 0.3-13.3 years), median age at listing was 30 months (range, 0.1-13.3 years), and the median waiting list time was 2.8 months (range, 0.3-14 months). The median time to return to the referral center from the time of transplant was 3 weeks (range, 2-8 weeks). The referral center treated 4 of 5 late rejection episodes. Angiography was undertaken in the transplant center at annual or biannual review. Outcomes for rejection, coronary vasculopathy, and survival were comparable between the referral and transplant centers.
Conclusions:
This report of shared care for pediatric transplant patients between 2 sovereign nations demonstrates good results, with comparable outcomes to the specialist transplant center. These data may encourage liberalization of follow-up in other centers.
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