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Pediatr Transplant. 2019 Sep 4:e13561. doi: 10.1111/petr.13561. [Epub ahead of print]

Hospital readmission following pediatric heart transplantation.

Author information

1
Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia.
2
Rho Federal Systems Division, Chapel Hill, North Carolina.
3
Labatt Family Heart Center, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada.
4
Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York.
5
Department of Pediatrics and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA (Feingold).
6
Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Missouri.
7
Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, New York.
8
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
9
Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
10
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
11
Transplantation Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
12
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.

Abstract

The frequency, indications, and outcomes for readmission following pediatric heart transplantation are poorly characterized. A better understanding of this phenomenon will help guide strategies to address the causes of readmission. Data from the Clinical Trials in Organ Transplantation for Children (CTOTC-04) multi-institutional collaborative study were utilized to determine incidence of, and risk factors for, hospital readmission within 30 days and 1 year from initial hospital discharge. Among 240 transplants at 8 centers, 227 subjects were discharged and had follow-up. 129 subjects (56.8%) were readmitted within one year; 71 had two or more readmissions. The 30-day and 1-year freedom from readmission were 70.5% (CI: 64.1%, 76.0%) and 42.2% (CI: 35.7%, 48.7%), respectively. The most common indications for readmissions were infection followed by rejection and fever without confirmed infection, accounting for 25.0%, 10.6%, and 6.2% of readmissions, respectively. Factors independently associated with increased risk of first readmission within 1 year (Cox proportional hazard model) were as follows: transplant in infancy (P = .05), longer transplant hospitalization (P = .04), lower UNOS urgency status (2/IB vs 1A) at transplant (P = .04), and Hispanic ethnicity (P = .05). Hospital readmission occurs frequently in the first year following discharge after heart transplantation with highest risk in the first 30 days. Infection is more common than rejection as cause for readmission, with death during readmission being rare. A number of patient factors are associated with higher risk of readmission. A fuller understanding of these risk factors may help tailor strategies to reduce unnecessary hospital readmission.

KEYWORDS:

pediatric heart transplantation; readmission

PMID:
31483086
DOI:
10.1111/petr.13561

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