Quality care close to home: Objectives and early outcomes of a second paediatric heart transplant service in Australia

Abstract

Aim We describe the experience of a new paediatric heart transplant (HT) centre in Australia. New South Wales offers quaternary paediatric cardiac services including comprehensive care pre‐ and post‐HT; however, perioperative HT care has previously occurred at the national paediatric centre or in adult centres. Internationally, perioperative HT care is highly protocol‐driven and a majority of HT occurs in low volume centres. Establishing a low volume paediatric HT centre in New South Wales offers potential for quality HT care close to home. Methods Retrospective review of programme data for the first 12 months was undertaken. Patient selection was audited against the programme's intended initiation criteria. Longitudinal patient data on outcomes and complications were obtained from patient medical records. Results The programme's initial phase offered HT to children with non‐congenital heart disease and no requirement for durable mechanical circulatory support. Eight patients met criteria for HT referral. Three underwent interstate transfer to the national paediatric centre. Five children (13–15 years, weight 36–85 kg) underwent HT in the new programme. Individual predicted 90‐day mortality was 1.3–11.6%, with increased risk for recipients transplanted from veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) and with restrictive/hypertrophic cardiomyopathies. Survival at 90 days and for duration of follow‐up is 100%. Observed programme benefits include mitigation of family dislocation and improved continuity of care within a family‐centred programme. Conclusion Audit of the first 12 months' activity of a second paediatric HT centre in Australia demonstrates adherence to proposed patient selection criteria and excellent 90‐day patient outcomes. The programme demonstrates feasibility of care close to home, providing continuity for all patients including those requiring increased rehabilitation and psychosocial support post‐transplantation.

A New Regional Pediatric Heart Transplant Service: new program, current expectations

“…The final tipping point to engage with the vulnerability of establishing a new service is typically driven by access issues such as those experienced by our own center during the COVID-19 pandemic. 2,3 The paper by Koubsky et al from Prague, Czechoslovakia, 4 nicely confirms that new services, such as a pediatric cardiac transplant program, can be commenced in a safe manner if certain caveats are met. Furthermore, the Czech group shows that this type of program is possible even for the highest risk patient groups including those who need durable mechanical bridging to cardiac transplantation or those patients who have had previous cardiac surgery for congenital cardiac lesions.…”

“…Within this context, establishing new services can be challenging with small patient volumes, magnifying outcomes both good and poor. The final tipping point to engage with the vulnerability of establishing a new service is typically driven by access issues such as those experienced by our own center during the COVID‐19 pandemic 2,3 . The paper by Koubsky et al from Prague, Czechoslovakia, 4 nicely confirms that new services, such as a pediatric cardiac transplant program, can be commenced in a safe manner if certain caveats are met.…”