Abstract
Purpose To characterize and trend in-hospital therapy, outcomes and cost of children admitted with acute rejection within 1y after heart transplantation (TX) over the last 10 y. Methods and Materials Retrospective study of PHIS database(national database with inpatient data from 43 not-for-profit, tertiary-care pediatric hospitals in the USA) from 2002-2010. Inclusion criteria: ICD-9 code for heart TX, and readmission with a code for acute rejection within 1y of heart TX. Results 478 patients (57% male) were readmitted for acute rejection a median of 51d (IQR 12-162d) after TX. Median age was 7y (IQR 1.6-13.5y) 69% were Caucasian. Median length of stay was 4d (IQR 3-9d) and overall mortality was 5%. 31% were admitted to the intensive-care unit and 16% were mechanically ventilated. ECMO was used in 4% and 0.6% received a VAD. Patients received: calcineurin inhibitors (98%), corticosteroids (93%), mycophenolate (70%), azathioprine (21%), immune globulins (21%), monoclonal antibodies (10%), cytomegalovirus immune globulin (8%), and methotrexate (0.6%). Time to readmit went from 29.5 d (13-136) in 2002 to 121d (28-258) in 2012 (p figure1 ] Conclusions The cost of treatment and in-hospital mortality of acute humoral or cellular rejection in children has increased over time. Time to readmission has increased, potentially signifying changes in early management.
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