Adolescence and Pediatric Heart Transplantation: Impact of Non-Adherence on Mortality: A Single-Center Experience

Heart transplantation represents the standard of care for pediatric patients with advanced heart failure. While outcomes have significantly improved in recent decades, adolescence remains a high-risk period marked by increased rejection rates and mortality, largely due to treatment non-adherence. This study aimed to analyze morbidity and mortality in adolescents undergoing heart transplantation at a single Brazilian center, focusing on the role of non-adherence. We conducted a retrospective review of medical records of 41 patients who underwent heart transplantation at our institution between 2002 and 2022. Patients transplanted during adolescence or who became adolescents after transplantation were included. We assessed episodes of rejection, major complications, and mortality, correlating outcomes with treatment adherence. Adolescents represented 54.5% of transplant recipients. This group exhibited higher rejection rates, with an average of 2.3 episodes per patient. Late mortality (>1 year after transplant) was predominantly rejection-related, with 61.5% of deaths directly linked to non-adherence to immunosuppressive therapy. Our findings reinforce that adolescents constitute a vulnerable group within pediatric heart transplantation, mainly due to the high rate of non-adherence to immunosuppressive treatment. Multidisciplinary strategies, such as psychological support, continuing education, and transition programs to adulthood, are essential to mitigate this risk and improve outcomes in this population.