Results of pediatric cardiac transplantation -- long-term results of a 15-year experience.
BACKGROUND
Heart transplantation (HTx) has increasingly become a therapeutic option for end-stage heart failure of any origin in children. Short- and mid-term results are promising. However, long-term outcome has been a matter of concern because of acute or chronic rejection and side effects of immunosuppression. We performed a retrospective study of up to 15-years of follow-up on this patient entity.


METHODS
Between 1988 and 2004, 58 HTx were performed in 55 children (cardiomyopathy (DCM) 32, congenital heart disease (CHD) 23, Re-HTx 3). Mean age was 9.1 +/- 7.2 years (4 days - 17.9 years). Twenty-nine patients had a total of 51 previous operations.


RESULTS
Operative mortality was 4/58 (6.8 %) due to primary graft failure. Late mortality was 7/54 (12.1 %) due to acute rejection (2), pneumonia (2), intracranial hemorrhage (1), suicide (1) and lymphoma (1). Mean follow-up was 5.2 +/- 4.2 years. One-, 5-, and 10-year survival was 86 %, 80 % and 80 %, respectively, and improved significantly after 1995 (92 % and 92 %; p = 0.04). Survival was comparable for DCM and CHD patients (1-year: 88 % vs. 82 %; p = 0.19; 5-years: 84 % vs. 77 %; p = 0.12). Three patients with therapy resistant rejection and assisted circulation required retransplantation and are alive. Freedom from acute rejection was 46 % with primary cyclosporine immunosuppression and 63 % with tacrolimus. Ninety-eight percent of the survivors are at home and in excellent cardiac condition.


CONCLUSIONS
Pediatric heart transplantation is a curative treatment for DCM and CHD with excellent clinical mid-term results. However, further follow-up is necessary to evaluate long-term side effects of immunosuppressants. Donor shortage remains a problem.
Groetzner
J
J
Department of Cardiac Surgery, Ludwig-Maximilians University Hospital Munich-Grosshadern, Munich, Germany. jgroetzner@t-online.de
Reichart
B
B
Roemer
U
U
Tiete
A
A
Sachweh
J
J
Kozlik-Feldmann
R
R
Netz
H
H
Daebritz
S
S
D002311:Cardiomyopathy, Dilated / Q000601:surgery; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006330:Heart Defects, Congenital / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D011788:Quality of Life; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors