Children with heart transplants: Lessons learned from 774 visits at a primary community clinic

Pediatr Transplant. 2020 Feb;24(1):e13617. doi: 10.1111/petr.13617. Epub 2019 Dec 27.

Abstract

Aims Unexpected decompensation of PHTRs may surprise, when the patient is at home. If the PHTR lives a distance from transplant center, the task of identifying risk factors of allograft rejection/dysfunction falls primarily on the PCP in the PCC, whether or not they are knowledgeable toward pediatric heart-transplantation. Methods We reviewed the medical reports of three heart-transplanted children in our periphery clinic between the years 2005 and 2019. Results The unexpected death of one patient, hours after he left our health facility, was the impetus for writing this article. Another heart transplant child attended our periphery clinic for 774 visits. Majority of visits were casual, others were scheduled, and the rest were for administrative affairs. We referred the PHTR to the transplantation center in 9% of all visits. In remaining 91% visits, we handled problems locally. Conclusions One of the important lessons we have learned through handling the PHTR at the PCC is that, during daily workflows and dealing with the occasional visits of a heart transplant child, related critical clinical information to allograft rejection or its dysfunction can easily evade from awareness of the attending physician. Through this study, we demonstrated that a program of summoning the PHTR to "initiated monthly visits" at the PCC enables the PCP to be maximally aware of critical clinical information, in addition to limiting futile referrals of 91% of the visits to specialized centers, without adversely affecting the prognosis.

Keywords: heart transplant; organ transplantation; pediatric heart transplant; pediatric transplantation; transplantation.

Publication types

  • Case Reports

MeSH terms

  • Aftercare / methods
  • Aftercare / organization & administration
  • Aftercare / statistics & numerical data
  • Child
  • Community Health Centers* / organization & administration
  • Community Health Centers* / statistics & numerical data
  • Fatal Outcome
  • Female
  • Graft Rejection / diagnosis*
  • Graft Rejection / therapy
  • Heart Transplantation*
  • Humans
  • Primary Health Care* / methods
  • Primary Health Care* / organization & administration
  • Primary Health Care* / statistics & numerical data
  • Referral and Consultation / organization & administration
  • Referral and Consultation / statistics & numerical data