講演情報
[I-AEPCYIA-1]Medical and Social Outcomes of Pediatric Heart Transplantation
○Yuka Hayashida, Hidekazu Ishida, Jun Narita, Ryo Ishii, Atsuko Kato, Masaki Hirose, Yuri Suehiro, Tatsuya Baba, Yasuji Kitabatake (Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan)
キーワード：
transplantation、outcome、survival
INTRODUCTION:Advancements in immunosuppressive therapy have improved the overall survival rate of pediatric heart transplant recipients. However, the current status of social reintegration among these patients remains unclear. Research on the social outcome is further complicated by cross-national differences in educational systems and labor laws, emphasizing the importance of country-specific studies.
METHODS:This retrospective study examined 74 patients who underwent heart transplantation under 18 years of age between 2000 and 2023, and were followed-up at Osaka University Hospital, Japan. Survival rates, pre- and post-transplant complications, and educational or occupational status were analyzed.
RESULTS:The cohort consisted of 34 males and 40 females, with a median age at transplantation of 6 years (interquartile range, IQR: 2–13). The median follow-up duration was 7 years (IQR: 5–13). Twelve deaths occurred during the observation period, with 5-year, 10-year, and 15-year survival rates of 91%, 91%, and 81%, respectively. Major post-transplant complications, including allograft rejection (14 cases, 19%), post-transplant lymphoproliferative disease (13 cases, 18%), kidney dysfunction (8 cases, 11%), and coronary artery vasculopathy (5 cases, 7%) were identified during the observational period. Excluding six patients who did not reach to school age, stable school attendance was achieved in 66 out of 68 patients (97%). Among the 39 patients aged 18 years or older, 15 (38%) were employed, 14 (36%) were enrolled in higher education, and 10 (26%) were neither employed nor enrolled in education. Univariate analysis revealed that pre-transplant cerebrovascular or neurodevelopmental disorders significantly hindered educational and occupational outcomes (P = 0.0018).
CONCLUSIONS:The mortality of pediatric heart transplantation in our hospital was better than international registry data. While educational outcomes in compulsory schools were favorable among pediatric heart transplant recipients in Japan, 26% of patients above age 18 were neither employed nor enrolled in education. Neurological complications emerged as a key risk factor for social reintegration.
METHODS:This retrospective study examined 74 patients who underwent heart transplantation under 18 years of age between 2000 and 2023, and were followed-up at Osaka University Hospital, Japan. Survival rates, pre- and post-transplant complications, and educational or occupational status were analyzed.
RESULTS:The cohort consisted of 34 males and 40 females, with a median age at transplantation of 6 years (interquartile range, IQR: 2–13). The median follow-up duration was 7 years (IQR: 5–13). Twelve deaths occurred during the observation period, with 5-year, 10-year, and 15-year survival rates of 91%, 91%, and 81%, respectively. Major post-transplant complications, including allograft rejection (14 cases, 19%), post-transplant lymphoproliferative disease (13 cases, 18%), kidney dysfunction (8 cases, 11%), and coronary artery vasculopathy (5 cases, 7%) were identified during the observational period. Excluding six patients who did not reach to school age, stable school attendance was achieved in 66 out of 68 patients (97%). Among the 39 patients aged 18 years or older, 15 (38%) were employed, 14 (36%) were enrolled in higher education, and 10 (26%) were neither employed nor enrolled in education. Univariate analysis revealed that pre-transplant cerebrovascular or neurodevelopmental disorders significantly hindered educational and occupational outcomes (P = 0.0018).
CONCLUSIONS:The mortality of pediatric heart transplantation in our hospital was better than international registry data. While educational outcomes in compulsory schools were favorable among pediatric heart transplant recipients in Japan, 26% of patients above age 18 were neither employed nor enrolled in education. Neurological complications emerged as a key risk factor for social reintegration.