Hollander Seth A, McElhinney Doff B, Almond Christopher S, McDonald Nancy, Chen Sharon, Kaufman Beth D, Bernstein Daniel, Rosenthal David N
Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA, USA.
Department of Cardiothoracic Surgery, LPCH Heart Center Clinical and Translational Research Program, Palo Alto, CA, USA.
Pediatr Transplant. 2017 Feb;21(1). doi: 10.1111/petr.12857. Epub 2016 Nov 27.
We report the patterns of rehospitalization after pediatric heart transplant (Htx) at a single center. Retrospective review of 107 consecutive pediatric Htx recipients between January 22, 2007, and August 28, 2014, who survived their initial transplant hospitalization. The frequency, duration, and indications for all hospitalizations between transplant hospitalization discharge and September 30, 2015, were analyzed. A total of 444 hospitalization episodes occurred in 90 of 107 (84%) patients. The median time to first rehospitalization was 59.5 (range 1-1526) days, and the median length of stay was 2.5 (range 0-81) days. There were an average of two hospitalizations per patient in the first year following transplant hospitalization, declining to about 0.8 per patient per year starting at 3 years post-transplant. Admissions for viral infections were most common, occurring in 93 of 386 (24%), followed by rule out sepsis in 61 of 386 (16%). Admissions for suspected or confirmed rejection were less frequent, accounting for 41 of 386 (11%) and 31 of 386 (8%) of all admissions, respectively. Survival to discharge after rehospitalization was 97%. Hospitalization is common after pediatric Htx, particularly in the first post-transplant year, with the most frequent indications for hospitalization being viral illness and rule out sepsis. After the first post-transplant year, the risk for readmission falls significantly but remains constant for several years.
我们报告了单中心小儿心脏移植（Htx）后的再住院模式。回顾性分析了2007年1月22日至2014年8月28日期间连续107例小儿心脏移植受者，这些受者在首次移植住院后存活。分析了移植住院出院至2015年9月30日期间所有住院的频率、持续时间和指征。107例患者中的90例（84%）共发生444次住院事件。首次再住院的中位时间为59.5天（范围1 - 1526天），中位住院时间为2.5天（范围0 - 81天）。移植住院后的第一年，每位患者平均住院两次，从移植后3年开始，每位患者每年的住院次数降至约0.8次。病毒感染导致的住院最为常见，在386次住院中占93次（24%），其次是排除败血症，在386次住院中占61次（16%）。疑似或确诊排斥反应导致的住院频率较低，分别占所有住院的41次（11%）和31次（8%）。再住院后出院生存率为97%。小儿心脏移植后住院很常见，尤其是在移植后的第一年，住院最常见的指征是病毒性疾病和排除败血症。移植后的第一年之后，再次入院的风险显著下降，但在几年内保持稳定。
