Gastrostomy tubes appear to be safe following pediatric orthotopic heart transplant

Impact of Immunosuppression on Complication Rates in Pediatric Gastrostomy Tube Placement

INTRODUCTION

Immunosuppressed children are vulnerable to post-operative complications. The purpose of this study is to determine if children who are immunosuppressed at gastrostomy tube (G-tube) placement experience higher rates of post-operative complications than children with normal immune function.

METHODS

Children ≤18 years-old who underwent G-tube placement at a high-volume tertiary children's hospital between June 2019-April 2022 were retrospectively identified. Patients who received chemotherapy or post-transplantation immunosuppressive therapy ≤3 months before or 30 days after G-tube placement were identified as the immunosuppressed cohort and 30-day postoperative complication rates were compared. Subset analysis was performed for immunosuppressed children who were neutropenic in the perioperative period.

RESULTS

Thirty-one (5.6 %) of 553 children who underwent G-tube placement were immunosuppressed. Immunosuppressed patients were older (median [IQR] 48 [19-156] months vs. 9 [4-31] months, p < 0.001). The majority underwent laparoscopic placement (71.1 %). There were significantly more PEG placements in the immunosuppressed cohort (22.6 % vs. 4.4 %, p < 0.001). There was no difference in 30-day complication rate between the immunosuppressed and immunocompetent cohorts (29.0 % vs. 34.5 %, p = 0.53); however, there was a higher rate of return to OR for the immunosuppressed cohort (9.7 % vs. 2.7 %, p = 0.03). Subset analysis of the high-risk neutropenic subgroup (n = 13, 41.9 %) revealed no difference in complication rates compared to the non-neutropenic immunosuppressed subgroup.

CONCLUSION

G-tube placement in immunosuppressed patients, including those with perioperative neutropenia, appears to be safe with a comparable safety profile to G-tube placement in children with normal immune function, with the exception of a higher rate of return to the OR within 30 days.

STUDY TYPE

Treatment study.

LEVEL OF EVIDENCE

Level III.

Rehabilitation in Pediatric Heart Failure and Heart Transplant

Survival of pediatric patients with heart failure has improved due to medical and surgical advances over the past decades. The complexity of pediatric heart transplant patients has increased as medical and surgical management for patients with congenital heart disease continues to improve. Quality of life in patients with heart failure and transplant might be affected by the impact on functional status that heart failure, heart failure complications or treatment might have. Functional areas affected might be motor, exercise capacity, feeding, speech and/or cognition. The goal of rehabilitation is to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. Some of these rehabilitation interventions such as exercise training have been extensively evaluated in adults with heart failure. Literature in the pediatric population is limited yet promising. The use of additional rehabilitation interventions geared toward specific complications experienced by patients with heart failure or heart transplant are potentially helpful. The use of individualized multidisciplinary rehabilitation program that includes medical management, rehabilitation equipment and the use of physical, occupational, speech and feeding therapies can help improve the quality of life of patients with heart failure and transplant.