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Pre-Transplant Diagnosis Asserts Significant Post-Transplant Burden on Readmissions and Reinterventions: A
Mario O'Connor1,2, Andrew Well1,2, Hugo R Martinez1,3
1Texas Center for Pediatric and Congenital Heart Disease, Dell Children's and UT Health, Austin, Texas, USA.
Insights
Congenital heart disease (CHD) and single ventricle (SV) diagnoses significantly increase readmission and reintervention risks after heart transplantation. Post-transplant care must be optimized to reduce this continued morbidity in pediatric patients.
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.
Purpose:
Pre-transplant (PreTX) diagnoses of congenital heart disease (CHD), including single ventricle (SV) CHD, are known to be associated with immediate post-operative morbidity and mortality. However, the impact on post-discharge health and morbidity has not been elucidated.
Methods:
The Pediatric Health Information Survey (PHIS) data was used to identify patients undergoing orthotopic heart transplantation (HT). We assessed hospital encounters for readmission, ICU care, and interventions within 1 year of heart transplantation after discharge from HT.
Results:
A total of 4087 patients were included in the analysis with the median age of 5.2 years. PreTX diagnosis was CHD in 28%, single ventricle CHD (SV) in 31%, cardiomyopathy, and other causes in 41%. A total of 2698 patients (66%) required hospital readmission within 1 year of discharge, of which 569 required more than two readmissions. The reason for readmission was cardiac in 22%, infectious in 35%, and non-cardiac in 43%. Using multivariable modeling, younger age, CHD, SV, Hispanic race, government insurance, longer post-TX hospital stay, longer ventilation needs, and dialysis use were associated with readmission risk (all p < 0.05). CHD and SV diagnosis, younger age, and longer post-TX stay were also risk factors for ICU-level readmission (all p < 0.05). Regression analysis showed that CHD (HR 2.7) and SV (HR 5.3) were highly predictive of reinterventions within 1 year. Lastly, the morbidity burden was calculated as days alive and outside hospital (DAOH) post TX. Younger age, SV, current era for transplantation, prolonged ventilation, and hospital stay post TX were all associated with lower DAOH.
Conclusion:
CHD and SV have a significant impact on continued morbidity post-TX, including the need for ICU-level readmission and reinterventions. The study also identifies race and post-TX morbidities as other important risk factors for readmissions and reinterventions. We need to study and improve the optimization of patients pre-and post-TX to mitigate this significant and continued risk.
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