Cardiac transplantation in pediatric patients: fifteen-year experience of a single center.
BACKGROUND
Pediatric heart transplantation is a surgical therapy for dilated cardiomyopathy and for complex congenital heart defects with low pulmonary artery resistance. However, it is still discussed as controversial because of uncertain long-term results. We report our experience with pediatric heart transplantation in a heterogeneous population.


METHODS
Since 1988, 50 heart transplants were performed in 47 patients (30 with dilated cardiomyopathy, 17 with congenital heart disease). Mean age was 9.4 +/- 6.9 years (range, 4 days to 17.9 years). Twenty-three patients had a total of 36 previous operations. Clinical outcome was evaluated retrospectively.


RESULTS
Perioperative mortality was 6% due to primary graft failure. Late mortality (12%) was caused by acute rejection (n = 2), pneumonia (n = 2), intracranial hemorrhage (n = 1), and suicide (n = 1). Mean follow-up was 5.24 +/- 3.6 years. Actuarial 1, 5, and 10 year survival was 86%, 86%, and 80% and improved significantly after 1995 (92% [1 year]; 92% [5 years]). There was no significant difference between patients with dilated or congenital heart disease (1 year: 86% vs 82%; 5 years: 83% vs 74%; 10 years 83% vs 74%; p = 0.62). Three patients with therapy resistant acute or chronic rejection and assisted circulation underwent retransplantation and are alive. Freedom from acute rejection after 5 years was 40% with primary cyclosporine immunosuppression regime and 56% with tacrolimus. Since the introduction of mycophenolate mofetil, freedom from acute rejection increased to 62%. All survivors are at home and in good cardiac condition.


CONCLUSIONS
Pediatric heart transplantation is the treatment of choice for end-stage dilated cardiomyopathy as for congenital heart disease with excellent clinical midterm results. It is a valid alternative to reconstructive surgery in borderline patients. However, further follow-up is necessary to evaluate the long-term side effects of immunosuppressants.
Groetzner
Jan
J
Department of Cardiac Surgery, Ludwig Maximilians University Hospital Munich-Grosshadern, Munich, Germany. jan.groetzner@med.uni-jena.de
Reichart
Bruno
B
Roemer
Ulrich
U
Reichel
Stefanie
S
Kozlik-Feldmann
Rainer
R
Tiete
Andreas
A
Sachweh
Joerg
J
Netz
Heinrich
H
Daebritz
Sabine
S
D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000453:epidemiology; D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000517:prevention & control; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000627:therapeutic use; D005858:Germany; D006084:Graft Rejection / Q000401:mortality / Q000517:prevention & control; D006330:Heart Defects, Congenital / Q000601:surgery*; D006333:Heart Failure / Q000209:etiology / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D006353:Heart-Assist Devices; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015993:Life Tables; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology / Q000209:etiology; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014655:Vascular Resistance; D014777:Virus Diseases / Q000453:epidemiology
D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D016572:Cyclosporine; D009173:Mycophenolic Acid; D015774:Ganciclovir; D016559:Tacrolimus