Mahle William T, Mason Kristen L, Dipchand Anne I, Richmond Marc, Feingold Brian, Canter Charles E, Hsu Daphne T, Singh Tajinder P, Shaddy Robert E, Armstrong Brian D, Zeevi Adriana, Iklé David N, Diop Helena, Odim Jonah, Webber Steven A
Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia.
Rho Federal Systems Division, Chapel Hill, North Carolina.
Pediatr Transplant. 2019 Nov;23(7):e13561. doi: 10.1111/petr.13561. Epub 2019 Sep 4.
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.
小儿心脏移植后再入院的频率、指征及结果目前尚无明确描述。更好地了解这一现象将有助于指导应对再入院原因的策略。利用儿童器官移植临床试验（CTOTC - 04）多机构合作研究的数据，以确定首次出院后30天和1年内再次入院的发生率及危险因素。在8个中心的240例移植手术中，227例患者出院并接受了随访。129例患者（56.8%）在1年内再次入院；71例有两次或更多次再入院。30天和1年无再入院率分别为70.5%（可信区间：64.1%，76.0%）和42.2%（可信区间：35.7%，48.7%）。再入院最常见的指征是感染，其次是排斥反应和未确诊感染的发热，分别占再入院病例的25.0%、10.6%和6.2%。与1年内首次再入院风险增加独立相关的因素（Cox比例风险模型）如下：婴儿期移植（P = 0.05）、移植住院时间较长（P = 0.04）、移植时较低的UNOS紧急状态（2/IB vs 1A）（P = 0.04）以及西班牙裔种族（P = 0.05）。心脏移植出院后的第一年经常发生再入院，其中前30天风险最高。感染作为再入院原因比排斥反应更常见，再入院期间死亡罕见。一些患者因素与再入院风险较高相关。更全面地了解这些危险因素可能有助于制定策略以减少不必要的再入院。
