Comparison of inhospital outcomes of pediatric heart transplantation between single ventricle congenital heart disease and cardiomyopathy

Abstract

Data investigating the impact of household income and other factors on SV patient status‐post‐Fontan palliation after heart transplantation are lacking. We aim to evaluate factors affecting outcomes after OHT in this population. The PHIS database was interrogated for either SV or myocarditis/primary CM who were 4 years or older who underwent a single OHT. There were 1599 patients with a median age of 13.2 years (IQR: 9.3‐16.1). Total hospital costs were significantly higher in the SV group ($408 000 vs $294 000, P < 0.0001), but as median household income increased, the risk of inhospital mortality, post‐transplant LOS, and LOS‐adjusted total hospital costs all decreased. The risk of inhospital mortality increased 6.5% per 1 year of age increase at the time of transplant. Patients in the SV group had significantly more diagnoses than those in the CM group (21 vs 15, P < 0.0001) and had longer total hospital LOSs as a result of longer post‐transplant courses (25 days vs 15, P < 0.0001). Increased median household income and younger age are associated with decreased resource utilization and improved inhospital mortality in SV CHD patients who undergo OHT. In conclusion, earlier consideration of OHT in this population, coupled with improved selection criteria, may increase survival in this population.

A systematic review of social determinants of health in pediatric organ transplant outcomes

“…90 Individual income/SES Associations between individual SES and post-transplant outcomes varied. Several studies found higher income levels or SES was associated with better health outcomes, including lower risk of postoperative mortality, 52 shorter length of hospitalization, 93 lower risk of rejection or graft failure, 16,52 and lower long-term mortality rates. 52 However, other studies found no differences in likelihood for transplant, 52 post-transplant length of stay, 52 or mortality 86 across SES.…”

Addressing Disparities in Pediatric Congenital Heart Disease: A Call for Equitable Health Care

“…For instance, lower‐income families have worse graft survival, while higher family income is linked to improved in‐hospital survival. 53 Black race and Medicaid insurance are also associated with medication nonadherence, which in turn leads to worse transplant outcomes. 54 Factors linked to nonadherence include lower parental education levels, parental psychosocial issues, nonprivate insurance, financial limitations, and family conflicts.…”