A Single Center Study of Mortality and Associated Risk Factors After Transfer of Care From a Pediatric to an Adult Heart Transplant Center

Purpose At many pediatric institutions, heart transplant recipients eventually transition to adult providers. Outcomes after this transfer of care are not well studied. Methods We conducted a single center review of pediatric heart transplant patients who underwent transfer of care to the adjacent adult heart transplant center. Patient mortality and associated variables were analyzed. Results Forty‐eight patients were transferred at a mean age of 19 ± 0.9 years, with 3.9 ± 2.7 years of follow‐up time after transfer. There were 14 (29.2%) patient deaths at a median time of 1.3 years after transfer. On survival analysis, Black race ( p < 0.001), public insurance ( p = 0.04), single parent household ( p = 0.057), treated rejection in the final year before transfer ( p < 0.001), and shorter interval between transplant and transfer of care ( p = 0.003) were all associated in a univariate fashion with mortality. On multivariable analysis, recent rejection (HR 6.29, 95% CI 1.6–25.1) and time between transplant and transfer of care (HR 0.75, 95% CI 0.6–1) were associated with an increased and decreased risk, respectively, of mortality. Conclusions Our results reveal the extent of mortality after transfer of care to an adult institution and suggest possible associations between mortality and the following risk factors: race, socioeconomic characteristics, older age at transplant, and recently treated rejection.