title: Outcome of shared care for pediatric cardiac transplantation between two nations with different health care systems.
abstract: BACKGROUND
  No data are available for the outcome of children undergoing cardiac transplantation with shared care programs in different countries. We sought to investigate the outcome of a shared care transplant program between 2 countries given the complex immunologic, cardiac, and psychologic needs of these young people.
  
  
  METHODS
  We investigated the results of a shared care program for children who underwent cardiac transplantation between our center in the Republic of Ireland and 2 centers in the United Kingdom over 2 decades.
  
  
  RESULTS
  Between 1990 and 2013, 22 patients underwent 23 cardiac transplants. The median age at transplant was 3.2 years (range, 0.3-13.3 years), median age at listing was 30 months (range, 0.1-13.3 years), and the median waiting list time was 2.8 months (range, 0.3-14 months). The median time to return to the referral center from the time of transplant was 3 weeks (range, 2-8 weeks). The referral center treated 4 of 5 late rejection episodes. Angiography was undertaken in the transplant center at annual or biannual review. Outcomes for rejection, coronary vasculopathy, and survival were comparable between the referral and transplant centers.
  
  
  CONCLUSIONS
  This report of shared care for pediatric transplant patients between 2 sovereign nations demonstrates good results, with comparable outcomes to the specialist transplant center. These data may encourage liberalization of follow-up in other centers.
authors.affiliation: Department of Paediatric Cardiology, Great Ormond Street National Health Service Trust, London, United Kingdom.
authors.forename: Jacob
authors.initials: J
authors.lastname: Simmonds
authors.affiliation: Department of Paediatric Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin.
authors.forename: Hellene
authors.initials: H
authors.lastname: Murchan
authors.affiliation: Department of Paediatric Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin.
authors.forename: Adam
authors.initials: A
authors.lastname: James
authors.affiliation: Department of Biostatistics, National Clinical Research Centre, Our Lady's Hospital, Crumlin, Dublin, and Ireland and Statistica Medica Ltd., Dublin, Republic of Ireland.
authors.forename: Gloria
authors.initials: G
authors.lastname: Crispino
authors.affiliation: Department of Biostatistics, National Clinical Research Centre, Our Lady's Hospital, Crumlin, Dublin, and Ireland and Statistica Medica Ltd., Dublin, Republic of Ireland.
authors.forename: John
authors.initials: J
authors.lastname: O'Brien
authors.affiliation: Department of Paediatric Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Crumlish
authors.affiliation: Department of Paediatric Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin.
authors.forename: Orla
authors.initials: O
authors.lastname: Franklin
authors.affiliation: Department of Paediatric Cardiology, Great Ormond Street National Health Service Trust, London, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Fenton
authors.affiliation: Department of Paediatric Cardiology, Great Ormond Street National Health Service Trust, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Burch
authors.affiliation: Department of Paediatric Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin. Electronic address: cmcmahon992004@yahoo.com.
authors.forename: Colin J
authors.initials: CJ
authors.lastname: McMahon
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation; D006755:Hospital Shared Services / Q000458:organization & administration*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007391:International Cooperation; D007494:Ireland; D053208:Kaplan-Meier Estimate; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom
keywords: antibody-mediated; assist device; cardiac failure; cardiac transplantation; cellular; pediatric; rejection; shared care; survival; vasculopathy