Long-term survivors of pediatric heart transplantation: a multicenter report of sixty-eight children who have survived longer than five years.
OBJECTIVE
Short-term survival after pediatric heart transplantation is now excellent, but ultimately the efficacy of this procedure will depend on duration and quality of survival. We sought to evaluate the clinical course of long-term survivors of heart transplantation in childhood.


METHODS
Patients who had undergone heart transplantation at the university hospitals of Stanford, Columbia, and Pittsburgh between 1975 and 1989 and survived longer than 5 years from transplantation were identified and their clinical courses retrospectively reviewed.


RESULTS
Sixty eight children have survived more than 5 years from transplantation, and 60 (88%) are currently alive with a median follow-up of 6.8 years (5 to 17.9 years). Thirteen have survived more than 10 years from transplantation. Renal dysfunction caused by immunosuppressive agents was common, and two patients required late renal transplantation. Lymphoproliferative disease or other neoplasm occurred in 12 patients, but none resulted in death. Coronary artery disease was diagnosed in 13 patients (19%), leading to retransplantation in eight. Death after 5 years was related to acute or chronic rejection in 5 of 8 cases. Two of the deaths were directly related to noncompliance with immunosuppressive medication. All survivors are in New York Heart Association class 1.


CONCLUSIONS
Long-term survival with good quality of life can be achieved after heart transplantation in childhood, though complications of immunosuppression remain common. Posttransplantation coronary artery disease is emerging as the main factor limiting long term graft and patient survival.
Sigfússon
G
G
Department of Pediatrics, University of Pittsburgh, Pennsylvania, USA.
Fricker
F J
FJ
Bernstein
D
D
Addonizio
L J
LJ
Baum
D
D
Hsu
D T
DT
Chin
C
C
Miller
S A
SA
Boyle
G J
GJ
Miller
J
J
Lawrence
K S
KS
Douglas
J F
JF
Griffith
B P
BP
Reitz
B A
BA
Michler
R E
RE
Rose
E A
EA
Webber
S A
SA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003327:Coronary Disease / Q000175:diagnosis; D006084:Graft Rejection / Q000188:drug therapy; D016027:Heart Transplantation; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007223:Infant; D007674:Kidney Diseases / Q000209:etiology / Q000503:physiopathology; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000209:etiology; D011669:Pulmonary Wedge Pressure; D011788:Quality of Life; D012092:Replantation; D017741:Survivors
D007166:Immunosuppressive Agents