Abstract Body: Introduction: Pediatric heart transplant (PHT) recipient survival has improved. Yet, neurologic morbidity related to heart failure and its treatment persist. It can affect the functional outcome, increase risk of major adverse events, prolong LOS and increase the use of rehabilitation therapies (RT). We aim to describe the clinical characteristics, functional status and RT use of PHT Pts with stroke during the PHT admission.

Methods: Retrospective cohort study of consecutive PHT Pts at a tertiary center between 09/01/2012 and 09/30/2022. Demographic, and pre-, intra-, and post-PHT clinical, brain imaging and RT (physical, occupational, speech and feeding therapy) data were collected up to PHT hospitalization. Data are presented as frequency (%) or median (Inter Quartile Range-IQR).

Results: Of the 83 PHT Pts 34(40%) of them had a stroke 20(59%) pre-PHT, 7(21%) post-PHT, 4(12%) pre- and post-PHT and unknown timing in 3(9%). Median age of HT in these Pts was 6 yrs(1,13) (Table 1), 21(62%) were male. CHD was the pre-PHT diagnosis in 21(62%) of stroke Pts, cardiomyopathy in 12(35%) and acquired heart disease in 1(3%). Mechanical circulatory support were used in 27(79%) PHT with stroke.

Total no. of distinct areas of neurologic injury on brain MRI was 85 (Table 2). Neurologic events per imaging were 2(1, 2). MCA was affected in 22(26%), PCA 8(9%), ACA 8(9%), MCA+ACA 5(6%), and MCA+PCA 2(2%). Additionally, 38(45%) were ischemic and 34(40%) were hemorrhagic strokes.

Of the acute and/or sub-acute brain MRI findings with known stroke dates(N=41), the week prior, 8(20%) of Pts had a cardiac surgery, 4(10%) had a cardiac cath, 3(7%) had a cardiac arrest, 7(17%) had an arrest+procedure, 5(12%) arrest+cath, 3(7%) had a cath+ procedure, and 1(3%) had an arrest+cath+procedure.

Of the 41 brain MRI findings with known stroke dates, 1 day prior, 8(24%) pts were on anticoagulation agents, 10(24%) on antiplatelet, 15(37%) were on both, and 8(20%) were on neither. Pts who required ECMO and/or VAD(76%) had more strokes.

Total LOS for Pts with strokes was 91 days(28, 167) vs. the total HT cohort 117 days(58, 186). Of the stroke Pts, Pre-HT and Post-HT RT were required in 27(79%) and 31(91%), respectively (Table 3). Acute inpatient rehabilitation was required in 9(26%).

Conclusions: Strokes are found in almost half of PHT Pts. Most of them occur pre-HT. Cause of stroke is likely multifactorial. Their functional status is frequently impacted and requires RT pre- and post-HT.