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Updated: Jan 1, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Children with heart transplants: Lessons learned from 774 visits at a primary community clinic
Nadim H Nasser1,2, Mohammad M Simri1, Nasim K Bishara1
1Clalit Health Organization, Haifa, Israel.
Insights
Pediatric heart transplant recipients (PHTRs) require vigilant monitoring. Regular, initiated monthly visits at periphery clinics improve primary care physician (PCP) awareness of allograft rejection and dysfunction, enhancing PHTR care.
Area of Science:
- Pediatric Cardiology
- Transplantation Medicine
- Primary Care Medicine
Background:
- Pediatric heart transplant recipients (PHTRs) can experience unexpected decompensation at home.
- Primary care physicians (PCPs) in periphery clinics (PCCs) often manage PHTRs remotely, potentially lacking specialized knowledge of pediatric heart transplantation.
- Identifying risk factors for allograft rejection or dysfunction is crucial for PHTRs managed in non-specialized settings.
Observation:
- A review of three pediatric heart transplant cases managed at a PCC between 2005 and 2019 highlighted challenges in monitoring.
- One case involved unexpected patient death shortly after discharge, prompting this study.
- A significant majority (91%) of patient visits to the PCC were managed locally, with only 9% requiring referral to the transplant center.
Findings:
- Critical clinical information regarding allograft rejection or dysfunction can be missed during routine PCC visits.
- A structured program of initiated monthly visits for PHTRs at the PCC significantly enhances PCP awareness of potential complications.
- This proactive approach minimizes unnecessary referrals to specialized centers without negatively impacting patient outcomes.
Implications:
- Implementing initiated monthly visits in PCCs can improve the early detection of allograft rejection or dysfunction in pediatric heart transplant recipients.
- Enhanced PCP awareness through structured follow-up can lead to more timely and appropriate interventions.
- This model optimizes resource utilization by reducing non-essential referrals to transplant centers, improving the overall management of PHTRs in primary care settings.
Abstract:
Aims Unexpected decompensation of PHTRs may surprise, when the patient is at home. If the PHTR lives a distance from transplant center, the task of identifying risk factors of allograft rejection/dysfunction falls primarily on the PCP in the PCC, whether or not they are knowledgeable toward pediatric heart-transplantation. Methods We reviewed the medical reports of three heart-transplanted children in our periphery clinic between the years 2005 and 2019. Results The unexpected death of one patient, hours after he left our health facility, was the impetus for writing this article. Another heart transplant child attended our periphery clinic for 774 visits. Majority of visits were casual, others were scheduled, and the rest were for administrative affairs. We referred the PHTR to the transplantation center in 9% of all visits. In remaining 91% visits, we handled problems locally. Conclusions One of the important lessons we have learned through handling the PHTR at the PCC is that, during daily workflows and dealing with the occasional visits of a heart transplant child, related critical clinical information to allograft rejection or its dysfunction can easily evade from awareness of the attending physician. Through this study, we demonstrated that a program of summoning the PHTR to "initiated monthly visits" at the PCC enables the PCP to be maximally aware of critical clinical information, in addition to limiting futile referrals of 91% of the visits to specialized centers, without adversely affecting the prognosis.
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