Heart- and heart-lung transplantation in children.
Since January 1987, 16 prepubertal children have undergone heart (13) or heart-lung (3) transplantation. Immunosuppression included cyclosporine and azathioprine and excluded steroids except in case of rejection. The indications for heart transplantation were hypoplastic left heart syndrome (4 infants, mean age = 2 months), congenital heart disease (4 patients, mean age = 5.7 years) and cardiomyopathy (5 patients, mean age = 2.8 years). There were 4 early deaths (acute graft failure in 2, pulmonary hypertension in 1, infection in 1) and 1 late death (heart failure at 3 months). The 8 survivors had a mean follow-up of 12 months (range 1-19 months). Late complications were minimal. There were 4 episodes of rejection in 2 patients. There was no infection, normal somatic growth and no systemic hypertension. Renal function remained within normal limits although mild-to-moderate tubulointerstitial lesions were found in 4 renal biopsies. Three children (9-11 years old) underwent heart-lung transplantation. The early postoperative course was difficult with 6 episodes of rejection and 5 infections. One patient died at 3 months from infectious complications. One child has a complete rehabilitation 8 months posttransplantation. The last patient is clinically well at 7 months but has a residual tracheal stenosis. The long-term fate of these children, and particularly the long-term effects of cyclosporine therapy are unknown. Heart and heart-lung transplantation remain under investigation but may be reasonable approaches for infants and children with end-stage cardiac and/or pulmonary disease.
Vouhé
P R
PR
Service de Chirurgie Cardiaque, Laënnec Hospital, Paris, France.
Le Bidois
J
J
Dartevelle
P
P
Touati
G
G
Pouard
P
P
Mauriat
P
P
Jayais
P
P
Sidi
D
D
Kachaner
J
J
Neveux
J Y
JY
D058186:Acute Kidney Injury / Q000503:physiopathology; D001379:Azathioprine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003524:Cyclosporins / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006084:Graft Rejection; D016027:Heart Transplantation; D016041:Heart-Lung Transplantation; D006801:Humans; D006973:Hypertension; D007223:Infant; D007231:Infant, Newborn; D011183:Postoperative Complications; D011379:Prognosis
D003524:Cyclosporins; D001379:Azathioprine