Long-Term Outcomes for Pediatric HT Patients Transitioning to Adult Care

Abstract

<h3>Purpose</h3> Long-term survival rates for pediatric heart transplant (HT) recipients continue to improve, increasing the number that will transition care to adult specialists. There are limited data evaluating a transition plan specific to pediatric HT recipients. The purpose of this study is to describe the transition of pediatric HT patients to the adult HT program at a single large transplant center. <h3>Methods</h3> We retrospectively reviewed all patients who underwent transition from pediatric to adult HT program at our center between Jan 2011 and June 2021. We collected demographic characteristics at time of HT and adverse events including graft rejection, infection, hemodynamics and renal function before and after the transition. We also collected psychosocial and psychiatric history, work/educational status and reports of poor medical adherence. <h3>Results</h3> 72 patients were identified,54.1% were male. Mean age at time of transition was 23 (Table1) after a median of 11.6 years in the pediatric program. Patients were followed for a median of 3.8 years post-transition. Overall patient survival following transition was 90.3%. New graft dysfunction was demonstrated in 17 patients with a mean EF decrease of 19.8 % and 10 patients (13.8%) required re-transplant during the study follow up. Incidence of cellular rejection (2R,3R rejection) was 27.7% before transition, while none of the patients experience cellular rejection after transition. AMR rates were 13.6% and 12.3 % before and after transition. Incidence of depression or other psychological conditions was 20.8%. <h3>Conclusion</h3> Excellent patient outcome can be achieved although with higher rates of re-transplantation due to graft dysfunction following transition from pediatric to adult care. Because the transition period occurs during a vulnerable time of emerging adulthood, the development of a formalized transition plan has the potential to favorably influence outcomes through additional clinical and psychosocial support.