title: Ten year survival after paediatric heart transplantation: a single centre experience.
abstract: 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.
authors.affiliation: 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>
authors.forename: Rosemary Radley
authors.initials: RR
authors.lastname: Smith
authors.forename: Jo
authors.initials: J
authors.lastname: Wray
authors.forename: Asghar
authors.initials: A
authors.lastname: Khaghani
authors.forename: Magdi
authors.initials: M
authors.lastname: Yacoub
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine