Abstract 15486: In-Hospital Outcomes After Cardiac Transplantation in Patients With Autism Spectrum Disorders: Insights From the National Inpatient Sample 2011-2019

Introduction: Many governing bodies and major international societies recommend against heart transplantation (HTx) in patients with severe cognitive-behavioral disabilities, however no clear criteria are offered to define severity. Patients with Autism Spectrum Disorders (ASD) may face systematic discrimination when being evaluated for HTx. There is a lack of data regarding outcomes after HTx in patients with ASD.

Methods: The NIS was queried from 2011-2019 for relevant ICD-9 and ICD-10 codes to identify patients with and without ASD who underwent HTx. Baseline characteristics and in-hospital outcomes between patients were compared. Binary logistic regression was used to adjust outcomes for significantly different baseline characteristics (p<0.05).

Results: We identified a weighted sample of 25,456 patients who underwent HTx, of which 80 had a concurrent diagnosis of ASD. Because less than .05% of the adult HTx population had ASD, the outcome analysis was restricted to the pediatric population. After restriction there were 3,769 pediatric patients who underwent HTx, of which 70 had a diagnosis of ASD. There were no significant differences in mortality, transplant related complications (acute graft rejection, acute graft failure, acute cardiac allograft vasculopathy and unspecified complications), cardiac arrest, periprocedural sepsis, mechanical circulatory support, stroke and bleeding/vascular complications between groups. While unadjusted values signaled a difference in the rate of complete heart block (CHB), there was no significant difference after application to a binary logistic regression model (CHB aOR: 1.83, 95% CI .70 to 4.77, p=0.22) Total cost of stay was significantly higher in the ASD group ($2,017,389±$2,136,742 versus $1,675,459±$1,604,926, p<0.05) while total length of stay was higher in the non ASD group (79.6±72 days versus 64.8±53.7 days, p<0.05).

Conclusion: There are no significant differences in outcomes after HTx between pediatric patients with and without ASD. The exclusion of patients with ASD from some transplant programs represents a major disparity in healthcare and transplant teams should consider a multidisciplinary approach to evaluating ASD patients for Htx.