Heart, heart-lung, and lung transplantation in the first year of life.
Seventeen infants less than 1 year of age have undergone heart (12), heart-lung (3), and lung (2) transplantation for end-stage cardiopulmonary disease. The infants undergoing heart transplantation had a mean age of 4.5 months (range, 19 days to 12 months) with the diagnosis of cardiomyopathy in 4 and congenital heart disease in 8. Four of the 8 patients (50%) had hypoplastic left heart syndrome. Actuarial survival at 1 and 2 years was 74% and compared favorably with the survival of older children at 1 and 2 years of 82% and 69%. The linearized rejection rate was less in infants as compared with children more than 1 year of age (0.61 versus 1.48 episodes per 100 patient days). In intermediate follow-up, no graft atherosclerosis has been noted. Immunosuppression has included a three-drug protocol of cyclosporine, azathioprine, and prednisone. A steroid taper to alternate day steroids or off completely by 6 months has been the goal and has been accomplished in 6 of 12 infants. Heart-lung and lung transplantation has been performed in 5 infants. One infant in each group died: 1 infant secondary to airway complications and sepsis and another due to pulmonary sepsis. A pulmonary lobe from a larger and older donor was transplanted into a 4-week-old infant as a single-lung transplant with good outcome. The 3 surviving infants are well 24, 18, and 2 months after transplantation. Obliterative bronchiolitis has not been clinically apparent in this group. These data support the clinical efficacy of heart, heart-lung, and lung transplantation in the first year of life.
Starnes
V A
VA
Department of Cardiothoracic Surgery, Stanford University Medical Center, California 94305.
Oyer
P E
PE
Bernstein
D
D
Baum
D
D
Gamberg
P
P
Miller
J
J
Shumway
N E
NE
D000206:Actuarial Analysis; D002423:Cause of Death; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006330:Heart Defects, Congenital / Q000601:surgery; D006331:Heart Diseases / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality; D016041:Heart-Lung Transplantation / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016040:Lung Transplantation; D008297:Male; D011183:Postoperative Complications
D016572:Cyclosporine