What are the Expectations for Length of Stay after Pediatric Heart Transplantation?

Abstract

As the field of heart transplantation (HTx) has undergone much growth over the last several years, it is essential that healthcare systems are able to anticipate the typical hospital courses these patients will take. This study aims to investigate the length of stay (LOS) in HTx over the last 20 years. The United Network for Organ Sharing (UNOS) database was used to identify patients ages 0-18 at time of listing for HTx between 2000-2019. This timeframe was divided into two eras: first (2000-2009) and second (2010-2019) eras. LOS was defined as number of days from HTx to discharge. 6990 HTx cases were identified. 3059 cases occurred in the first era and 3931 in the second. Overall, length of stay [median days (IQR)] was 18 (12-32) and was increased in the second era compared to the first [19 (13-34) vs 17 (11-30), p<0.001]. Specifically by age, LOS for infants was 24 (15-44), for ages 2-11 was 17 (12-29), and for ages 12-18 was 15 (11-23). Compared to those who did not have each of the following, patients on ECMO (p<0.001), on a ventilator (p<0.001), with renal dysfunction (eGFR<60 mL/min/1.73m2, p<0.001), or with hepatic dysfunction (total bilirubin≥1mg/dl, p=0.039) at time of HTx had longer LOS (Table 1). Patients with MCS (VAD or TAH) pre-HTx had similar LOS to those without (p=0.107). LOS was longer for CHD patients than cardiomyopathy patients (p<0.001). On KM analysis, post-HTx survival in the second era (one-year survival 93%) was better than in the first era (one-year survival 88%, p<0.001). Over the past two decades, HTx patients who are younger, have pre-HTx end-organ dysfunction or have congenital heart disease consistently have longer LOS. With these stable patterns, healthcare moving towards a bundled-care system, and an increase in UNOS required & institutional Quality Improvement projects, establishing benchmarks and expectations in pediatric post-HTx LOS is important.