Heart transplantation in children: clinical outcome during the early postoperative period.
As improved understanding of transplant-related death should improve survival, we report a single center's experience with pediatric heart transplantation including potential risk factors and causes of death during the early postoperative period. This prospective longitudinal study involved 51 pediatric patients ranging in age from 12 days to 15.1 yr (median: 3 yr). The following pretransplant risk factors were evaluated: diagnosis, age at transplantation, recipient sex, weight and blood type, blood type match, donor/recipient sex match, weight ratio, ischemic time, recipient's status, requirement for mechanical ventilation or circulatory support, dialysis, or inotropic support at transplantation. We also determined the actuarial survival, clinical outcomes, and causes of death in this population. Survival was 86% during the early postoperative period (</=30 days), 79.3% at 1 yr, and 76.8% at 3 yr. Seven patients died during the early postoperative period (primary graft failure, rejection, and infection). However, there was no difference in the frequency of any of the risk factors analyzed between these patients and those who did not experience early death. There was a correlation between the duration of intubation after transplantation and pretransplant risk factors (diagnosis, recipient status, requirement for dialysis, inotropic and mechanical ventilation support). Our findings indicate that promising short-term results can be obtained with pediatric transplantation. Although we identified no specific risk factors in this study for death, improved rejection surveillance and treatment strategies remain important goals in pediatric heart transplantation. Retransplantation had high mortality during the perioperative period.
Azeka
Estela
E
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. estela_azeka9@hotmail.com
Auler
José O C
JO
Marcial
Miguel B
MB
Fumagalli
Fabio
F
Ramires
José A F
JA
D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D006084:Graft Rejection / Q000175:diagnosis / Q000517:prevention & control; D006085:Graft Survival; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D007165:Immunosuppression Therapy; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008137:Longitudinal Studies; D011183:Postoperative Complications; D011184:Postoperative Period; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome