Psychiatric Comorbidities in Pediatric HT Patients Transitioning to Adult Care

Purpose

The transition from pediatric to adult care occurs during a vulnerable time of emerging adulthood (between 18 and 25 years of age) for pediatric heart transplant (HT) recipients, and multiple factors can lead to poor health outcomes. Disorders of depression, anxiety and adjustment disorder are common in this population and are associated with medication non-adherence and adverse patient outcomes. The purpose of this study is to explore the psychosocial history of pediatric HT recipients transferring to adult care in order to identify necessary areas for support when developing a formalized transition plan.

Methods

We retrospectively reviewed all patients who underwent transition from the pediatric to the adult HT program at our center between January 2011 and June 2021. We collected demographic characteristics at time of HT and adverse events including graft rejection, infection, hemodynamics and renal function before and after the transition. We also collected psychosocial history, work/educational status and reports of poor medication adherence at the time of transition.

Results

72 patients were identified, 54.1% were male and 54.2% were white. Heart failure etiology was predominantly dilated cardiomyopathy (59.7%) and congenital heart disease (20.7%). The mean age at time of transplant was 13 years and the mean age at time of transition visit was 23 years. 76.3% were living with parents/fxandparents, 81.9% completed high school and 50% were employed at time of transition. 30% had reports of poor medication adherence during adolescence and 20.8% had a psychiatric diagnosis. 27.7% reported active substance use. Patients were followed for a median of 3.8 years following transition to adult care and overall survival was 90.3%. All seven patients that died following their transition had a history of psychiatric illness or substance use.

Conclusion

We observed relatively high rates of psychiatric illness, substance use and poor medication adherence in our population of adolescent and young adult HT recipients transferring to adult care, all of which can contribute to adverse patient outcomes. A formalized transition plan should focus on robust mental health services and substance use counseling in order to favorably influence outcomes following their transition.