In-Hospital Outcomes of Admissions and 30-day Re-Admissions for Acute Allograft Rejection after Heart Transplantation

Abstract

Purpose The incidence of acute cardiac allograft rejection and mortality after heart transplantation (HT) have declined. We aimed to investigate the clinical outcomes of acute cardiac allograft rejection after HT requiring hospitalization. Methods Two distinct cohort were analyzed. The National Inpatient Sample (NIS) was queried to identify HT recipients admitted for acute rejection between 2015 to 2017 and analyze clinical outcomes and respective predictors. The National Readmission Database (NRD) was utilized to identify patients who underwent heart transplantation from 2016 to 2017 to analyze 30-day readmission. Results A total of 3,790 patients were admitted for HT rejection in the NIS cohort. Serious adverse events such as death in 4.1%, ventricular tachycardia in 5.4%, cardiogenic shock in 10.8% and use of extracorporeal membrane oxygenation in 2.5% were found. Female gender was associated with in-hospital death (odds ratio [OR] 4.48, 95% confidence interval [CI] 1.52-13.1, p=0.006). Younger age and end-stage renal disease were identified as independent predictors of transplant graft failure (OR 0.95, 95% CI 0.93-0.98, p=0.001, OR 3.65, 95% CI 1.22-10.99, p=0.021, respectively). Among 5,817 patients who were admitted for HT in the NRD cohort, 209 (3.6%) were readmitted within 30 days for transplant rejection with most occurring within 15 days. Younger age and female gender were associated with significantly increased risk of 30-day readmission for transplant rejection (OR 0.99, 95% CI 0.98-1.00, p=0.043; OR 1.43, 95% CI 1.00-2.03, p=0.048, respectively). No cases of mortality and utilization of mechanical circulatory support were identified. Conclusion Although early re-admissions for acute rejection after HT are infrequent and not associated with serious adverse effects, overall admissions for acute rejection are not uncommon and serious adverse events occur in a portion of these patients.