Ten year survival after paediatric heart transplantation: a single centre experience.
OBJECTIVE
To report 10 years survival in children under the age of 16 years undergoing heart transplantation in a single institution.


METHODS
One hundred and thirty nine/one hundred and ninety three patients (73%) survived more than 1 year after transplant. Seventy four (53%) of these survived more than 10 (10.0-20.1) years. Age at operation was 10 days-15.5 (mean 8.1) years. Patients were maintained on ciclosporin and azathiaprine alone. Routine steroids only given to 4 patients for either persistent rejection or deteriorating renal function. Rejection diagnosed on clinical or echocardiographic grounds. No routine biopsies were performed. Bi-annual coronary angiography was used to diagnose graft coronary disease.


RESULTS
Graft coronary disease was found in 8 patients (11%), 2 were re-transplanted and have survived 4.3-7.2 years since. Two patients are alive without intervention 2.0-13.0 years from initial diagnosis. Two patients have undergone interventional procedures 11 and 16 years after transplantation and are alive 3 and 4 years, respectively, later. Seven patients have had post transplant lymphoproliferative disease (PTLD) and 6 have had no recurrence for 3-13 years after treatment. Impaired renal function with abnormal serum creatinine levels is increasingly common-11 patients have developed end stage renal failure, 7 requiring renal transplantation, hypertension occurred in only 3 patients other than those in renal failure. Late rejection episodes associated with probable non-adherence occurred in 7 patients. There were 10 late deaths; 2 from graft coronary disease; 1 from PTLD; 3 from renal failure; 3 from acute rejection and 1 from infection. Conditional actuarial survival from 1 year post transplant was 76 and 67% at 10 and 15 years, respectively.


CONCLUSIONS
Survival for more than 10 years is increasingly realistic. In this age group adherence and deteriorating renal function are major challenges.
Smith
Rosemary Radley
RR
Royal Brompton, Harefield NHS Trust, Paediatric Surgical Unit, Harefield Hospital, Harefield, Middlesex UB9 6JH, UK. r.radley-smith@rbh.nthames.nhs.uk <r.radley-smith@rbh.nthames.nhs.uk>
Wray
Jo
J
Khaghani
Asghar
A
Yacoub
Magdi
M
D001379:Azathioprine / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000276:immunology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging; D016572:Cyclosporine / Q000627:therapeutic use; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000000981:diagnostic imaging; D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000150:complications; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000276:immunology; D015996:Survival Rate; D014463:Ultrasonography
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine