Outcome after pediatric heart transplantation: two decades of a single center experience.
BACKGROUND
Twenty years after the first successful pediatric heart transplantation (HTx), the long-term outcome of this population is still unknown. Current study analyzes our results in pediatric HTx population.


RESULTS
Between 1985 and 2005, we performed 604 HTx. Forty-three patients (7%) were less than 18-years old and six patients were less than 1-year old. Mean age at HTx was 9.7+/-6.3 years (38 days-18 years). Indications were: cardiomyopathy in 33 patients (76%), congenital in 9 (21%), tumor in 1 (3%). Chronic immunosuppression was Cyclosporine A and Azathioprine-based. Overall survival at Kaplan-Meier analysis (CI 95%) was 82.5% at 1-year post-HTx, 73.5% at 5 years, 72.2% at 10 years, 62.1% at 15 years, and 49.3% at 20 years, respectively. We had 14 deaths (32%): 7 within the first year after HTx (early mortality, EM), 7 occurred later (late mortality, LM). Causes of EM were: graft failure (43%), acute rejection (43%) and post transplant lymphoproliferative disease (14%). Causes of LM were: neoplasms (57%), infection (28%), graft vasculopathy (15%). At late follow-up, cardiac function, somatic and psycoaffective development were normal. Fifteen patients (34%) developed neoplasms, nine patients (21%) hypertension, and three patients (8%) developed kidney dysfunction. Neoplasms were found to be an independent predictor of outcome (p=0.039) (OR=7).


CONCLUSIONS
Overall survival in the pediatric population is better than adults' population (62.1 vs 48% at 15 years after HTx). Neoplasms were the main comorbidities and causes of LM: at multivariate analysis, their incidence was related with hematic Cyclosporine A levels after 10 years from HTx (p=0.01).
Gambino
Antonio
A
Department of Cardiovascular Surgery, University of Padova, Padova, Italy.
Cerutti
Alessia
A
Feltrin
Giuseppe
G
Toscano
Giuseppe
G
Tarantini
Giuseppe
G
Milanesi
Ornella
O
Angelini
Annalisa
A
Gerosa
Gino
G
D000293:Adolescent; D009202:Cardiomyopathies / Q000150:complications / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000401:mortality / Q000601:surgery; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007223:Infant; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000209:etiology; D008297:Male; D009369:Neoplasms / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D003404:Creatinine