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A Single Center Pediatric Heart Recipients to Adult Services Retrospective Study of Sentinel Events Using Statistical Analysis

Adams, Sherrie; Wigger, Mark A.

doi: 10.1097/

Heart Transplant, Vanderbilt Medical Center, Nashville, TN, United States.

Purpose: This first 12–24 months of transition between pediatric and adult programs haves been shown to have increased instances of rejection and, graft dysfunction leading to sentinel events. This is a study of Vanderbilt Heart transplant transition program’s data since its initiation in 2010. Endpoints were the number of sentinel events (death or graft failure) and sentinel event-free survival after transplant and transition.

Methods: Patients who transitioned from the pediatric to adult programs were identified. They began an 18–24 months transition between programs using an overlapping model for a short period to ensure success. Combined clinical teams met with the patient at the first transition clinic to promote collaboration and trust. Data was retrospectively analyzed using Kaplan-Meier methods and are summarized as mean (±SD), mean (95%CI), and survival percentages at benchmark time points.

Results: 25 patients have transitioned at an average age of 23 ± 3 years (range: 19–28) and 14 ± 8 years (range: 1–28) post-transplant. 7 sentinel events were identified. 4 events were due to cardiopulmonary arrest attributed to cardiac graft vasculopathy ischemia that may have derived from medication non-compliance by history of low immunosupression levels. There was 1 suicide and 2 graft failures with re-transplantation. Mean sentinel event-free survival was 23.9 years (CI: 20.9, 26.9) after transplant and 4.3 years (CI: 3.3, 5.4) after transition. One, 2 and 5-year sentinel event-free survival percentages after transition were 95%, 79% and 56%, and corresponding patient survival percentages were 100%, 84% and 67%.

Conclusion: Our data demonstrates success of our transition program, but with 7 events recorded. These are a complex group of patients that needs close guidance/monitoring during transition from a pediatric centered to adult centered services. We continue to build our program to meet new and existing needs. Our efforts will continue to work toward an effective transitional care model to ensure the ongoing success and lives of these young adult patients. Based upon program results/data we are increasing more frequent clinic visits that are NP driven, social worker intervention at least 2 times a year, initial pharmacy interview with pharmacy medication monitoring/intervention, and closer monitoring of Allomap/lab results, focusing on immunosupression levels.

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