title: Rehospitalization after pediatric heart transplantation: Incidence, indications, and outcomes.
abstract: We report the patterns of rehospitalization after pediatric heart transplant (Htx) at a single center. Retrospective review of 107 consecutive pediatric Htx recipients between January 22, 2007, and August 28, 2014, who survived their initial transplant hospitalization. The frequency, duration, and indications for all hospitalizations between transplant hospitalization discharge and September 30, 2015, were analyzed. A total of 444 hospitalization episodes occurred in 90 of 107 (84%) patients. The median time to first rehospitalization was 59.5 (range 1-1526) days, and the median length of stay was 2.5 (range 0-81) days. There were an average of two hospitalizations per patient in the first year following transplant hospitalization, declining to about 0.8 per patient per year starting at 3 years post-transplant. Admissions for viral infections were most common, occurring in 93 of 386 (24%), followed by rule out sepsis in 61 of 386 (16%). Admissions for suspected or confirmed rejection were less frequent, accounting for 41 of 386 (11%) and 31 of 386 (8%) of all admissions, respectively. Survival to discharge after rehospitalization was 97%. Hospitalization is common after pediatric Htx, particularly in the first post-transplant year, with the most frequent indications for hospitalization being viral illness and rule out sepsis. After the first post-transplant year, the risk for readmission falls significantly but remains constant for several years.
authors.affiliation: Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Hollander
authors.affiliation: Department of Cardiothoracic Surgery, LPCH Heart Center Clinical and Translational Research Program, Palo Alto, CA, USA.
authors.forename: Doff B
authors.initials: DB
authors.lastname: McElhinney
authors.affiliation: Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Almond
authors.affiliation: Solid Organ Transplant Services, Lucile Packard Children's Hospital, Stanford, Palo Alto, CA, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: McDonald
authors.affiliation: Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Beth D
authors.initials: BD
authors.lastname: Kaufman
authors.affiliation: Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bernstein
authors.affiliation: Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: David N
authors.initials: DN
authors.lastname: Rosenthal
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000523:psychology / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011788:Quality of Life; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications; D016896:Treatment Outcome; D014777:Virus Diseases / Q000150:complications; D055815:Young Adult
keywords: outcomes; pediatric; quality of life; rehospitalization; transplantation