Readmission in the First Year Following Pediatric Heart Transplantation: Incidence, Indications, and Risk Factors

Abstract

Purpose Readmission is common following pediatric heart transplantation (HT), based on existing single center data. The nationwide incidence of rehospitalization after HT has not been reported. We aimed to assess the incidence, risk factors, and indications for rehospitalization in pediatric HT recipients using a nationwide multicenter linked database. Methods The Scientific Registry of Transplant Recipients and Pediatric Health Information System databases were linked at the patient level using indirect identifiers (2002-2016). All pediatric HT recipients who survived to discharge were included. The frequency, timing of, and indication for all-cause readmissions in the first year following initial discharge were assessed. Multivariable logistic regression examined risk factors for readmission with standard error estimates adjusted for clustering within centers. Results A total of 2870 HT recipients from 29 centers were included. Of these, 1835 (63.9%) were readmitted within the first post-HT year (total of 5428 admissions). Readmission rates varied across transplant centers from 46% (1 center) to 100% (3 centers). For patients who were rehospitalized, the median number of readmissions was 2 (IQR 1-4) and the median time to first readmission was 29 days (IQR 9-99 days). Risk factors independently associated with readmission included age 30 days (AOR 1.4, 95%CI 1.1-1.9). Cardiac diagnoses, including rejection and/or concern for rejection, were the most common indications for readmission (N=2213, 40.8%), followed by infection/fever (N=1222, 22.5%), and respiratory diagnoses (N=393, 7.2%). Conclusion Rehospitalization is common in the first year following pediatric HT, with considerable variation in readmission rates across centers. Younger age, congenital heart disease, and a more complicated post-HT course increase the risk for subsequent readmission. Risk stratification based on these factors may serve to guide decision-making in determining discharge readiness and planning.