Pre-Transplant Diagnosis Asserts Significant Post-Transplant Burden on Readmissions and Reinterventions: A...

Area of Science:

• Pediatric Cardiology
• Transplantation Medicine
• Congenital Heart Disease Research

Background:

• Congenital heart disease (CHD), including single ventricle (SV) conditions, is linked to immediate post-heart transplant (HT) complications.
• The long-term impact of pre-transplant CHD and SV diagnoses on post-discharge health remains understudied.

Purpose of the Study:

• To evaluate the association between pre-transplant CHD/SV diagnoses and post-discharge morbidity after pediatric heart transplantation.
• To identify risk factors for readmission, intensive care unit (ICU) readmission, and reinterventions within one year post-HT.

Main Methods:

• Utilized the Pediatric Health Information Survey (PHIS) database to identify pediatric patients undergoing orthotopic heart transplantation (HT).
• Assessed hospital encounters for readmissions, ICU care, and interventions within one year of HT discharge.
• Employed multivariable and regression modeling to analyze risk factors.

Main Results:

• Of 4087 patients, 66% experienced readmission within one year; cardiac and infectious causes were prominent.
• Pre-transplant CHD and SV diagnoses were significant predictors of readmission, ICU readmission, and reinterventions (HR 2.7 for CHD, HR 5.3 for SV).
• Younger age, longer post-transplant hospital stay, and prolonged ventilation were associated with increased readmission risk and lower days alive outside hospital (DAOH).

Conclusions:

• Pre-transplant CHD and SV diagnoses substantially contribute to ongoing morbidity post-heart transplantation.
• Race and post-transplant morbidities are critical factors influencing readmission and reintervention rates.
• Optimizing pre- and post-transplant care is essential to mitigate the significant risks faced by these patients.