Abstract 3531: When Pediatric Heart Transplant Recipients Become Adults Does Transition to Adult Care Affect Outcomes?
Background: The transition of pediatric renal transplant recipients to adult transplant centers has been associated with poor outcomes. The effect of this transition on pediatric heart transplant recipients is unknown.
Methods: We retrospectively reviewed the survival, rejection, and new-onset coronary disease of 20 pediatric heart transplant recipients who were transitioned from St. Louis Children’s Hospital (SLC) to adult heart transplant centers. Multivariate models of death were created using 1597 patients in the Cardiac Transplant Research Database (CTRD) transplanted between 18 – 45 years of age and 2493 patients in the Pediatric Heart Transplant Study (PHTS), respectively. The PHTS death model was supplemented by adding an intercept term for the effect of SLC as an institution to both the early and late phase of the model. The number of expected deaths after transition for each model was then predicted by calculating the cumulative hazard for each patient from transplant to follow-up and then subtracting from that the cumulative hazard from transplant to transition. The resulting difference was the calculated expected deaths after transition for each patient which was then summed and compared to the observed number of deaths.
Results: Transitioned pediatric patients were followed for a median of 4.4 years (range of 0.92–14.5years) after transition with a survival of 100% at 1, 74% at 5, and 56% at 10 years after transition. Freedom from rejection and coronary disease was 86% and 95% at 1 and 68% and 69% at 5 years after transition respectively. Significant risk factors for constant phase mortality in the PHTS model were: African-American race (RR2.8, p<0.0001) and RVAD support at transplant (RR 2.2, p<0.02) and in the CTRD model: African-American race (RR 2.8, p<0.0001) younger age at transplant (RR 1.6, p=0.002) and cigarette smoking pre-transplant (RR 1.5, p=0.0007). Compared to the observed 6 deaths in the SLC patients, the PHTS model predicted 4.8 deaths (p=0.6) and the CTRD model predicted 5.7 deaths (p=0.9).
Conclusions: This pilot study suggests that adult pediatric heart transplant patients have a high mortality similar to young adult heart transplant recipients which may occur regardless of where they receive their care.