O'Connor Mario, Well Andrew, Martinez Hugo R, Norris Laura R, Das Bibhuti, Deshpande Shriprasad R
Texas Center for Pediatric and Congenital Heart Disease, Dell Children's and UT Health, Austin, Texas, USA.
Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Austin, Texas, USA.
Pediatr Transplant. 2025 Nov;29(7):e70180. doi: 10.1111/petr.70180.
Pre-transplant (PreTX) diagnoses of congenital heart disease (CHD), including single ventricle (SV) CHD, are known to be associated with immediate post-operative morbidity and mortality. However, the impact on post-discharge health and morbidity has not been elucidated.
The Pediatric Health Information Survey (PHIS) data was used to identify patients undergoing orthotopic heart transplantation (HT). We assessed hospital encounters for readmission, ICU care, and interventions within 1 year of heart transplantation after discharge from HT.
A total of 4087 patients were included in the analysis with the median age of 5.2 years. PreTX diagnosis was CHD in 28%, single ventricle CHD (SV) in 31%, cardiomyopathy, and other causes in 41%. A total of 2698 patients (66%) required hospital readmission within 1 year of discharge, of which 569 required more than two readmissions. The reason for readmission was cardiac in 22%, infectious in 35%, and non-cardiac in 43%. Using multivariable modeling, younger age, CHD, SV, Hispanic race, government insurance, longer post-TX hospital stay, longer ventilation needs, and dialysis use were associated with readmission risk (all p < 0.05). CHD and SV diagnosis, younger age, and longer post-TX stay were also risk factors for ICU-level readmission (all p < 0.05). Regression analysis showed that CHD (HR 2.7) and SV (HR 5.3) were highly predictive of reinterventions within 1 year. Lastly, the morbidity burden was calculated as days alive and outside hospital (DAOH) post TX. Younger age, SV, current era for transplantation, prolonged ventilation, and hospital stay post TX were all associated with lower DAOH.
CHD and SV have a significant impact on continued morbidity post-TX, including the need for ICU-level readmission and reinterventions. The study also identifies race and post-TX morbidities as other important risk factors for readmissions and reinterventions. We need to study and improve the optimization of patients pre-and post-TX to mitigate this significant and continued risk.
已知先天性心脏病（CHD）的移植前（PreTX）诊断，包括单心室（SV）CHD，与术后即刻的发病率和死亡率相关。然而，其对出院后健康和发病率的影响尚未阐明。
使用儿科健康信息调查（PHIS）数据来识别接受原位心脏移植（HT）的患者。我们评估了心脏移植出院后1年内因再次入院、重症监护病房（ICU）护理和干预而进行的医院诊疗情况。
共有4087例患者纳入分析，中位年龄为5.2岁。PreTX诊断为CHD的占28%，单心室CHD（SV）的占31%，心肌病及其他原因的占41%。共有2698例患者（66%）在出院后1年内需要再次入院，其中569例需要再次入院两次以上。再次入院的原因，心脏相关的占22%，感染相关的占35%，非心脏相关的占43%。使用多变量模型分析，年龄较小、CHD、SV、西班牙裔种族、政府保险、移植后住院时间较长、通气需求时间较长以及使用透析与再次入院风险相关（所有p<0.05）。CHD和SV诊断、年龄较小以及移植后住院时间较长也是ICU级再次入院的危险因素（所有p<0.05）。回归分析表明，CHD（风险比[HR]2.7）和SV（HR 5.3）对1年内再次干预具有高度预测性。最后，发病率负担以移植后存活且出院后的天数（DAOH）计算。年龄较小、SV、当前移植时代、通气时间延长以及移植后住院时间均与较低的DAOH相关。
CHD和SV对移植后持续发病率有显著影响，包括需要ICU级再次入院和再次干预。该研究还确定种族和移植后发病率是再次入院和再次干预的其他重要危险因素。我们需要研究并改进移植前后患者的优化管理，以减轻这种重大且持续的风险。
