Heart transplantation in children: clinical outcomes in a single center.
BACKGROUND
Despite being accepted as the best treatment for end-stage heart diseases, the long-term benefit of heart transplantation in children remains a matter of controversial debate. This study aimed to evaluate our clinical experience with heart transplantation in children.


METHODS
From March 1989 to December 1999, 93 consecutive orthotopic heart transplantations in children (less than 18 years of age) were performed at the Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW in Bad Oeynhausen, Germany. Clinical data were retrieved from a computerized database. Follow-up information was 100% completed.


RESULTS
The main indications for heart transplantation were dilated cardiomyopathy (68%) and congenital heart disease (31%). Early mortality risk was 14% +/- 3.6%. Primary graft failure (39%) was the main cause of early death. Total follow-up time was 694 patient-years (mean, 104.1 +/- 42.8 months). Twenty-three patients died during follow-up, resulting in 33 of 1,000 patient-years of late mortality rate. Acute rejection (43%) and allograft vasculopathy (26%) were attributed to late mortality. The 1-, 5-, 10-, and 15-year survival was 83%, 74%, 63%, and 50%, respectively. Recipient age less than one year (p = 0.02) and ischemia time greater than 300 minutes (p = 0.04) were associated with decreased survival. Social activities at the end of follow-up were school (69%), working (19%), and at home (12%).


CONCLUSIONS
Heart transplantation is a rational and durable treatment option for children with end-stage heart diseases. The long-term outcomes and quality of life after heart transplantation in children are encouraging.
Tjang
Yanto Sandy
YS
Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center, North Rhine Westphalia/University Hospital of Bochum, Bad Oeynhausen, Germany. ystjang@hotmail.com
Blanz
Ute
U
Hornik
Lech
L
Tenderich
Gero
G
Morshuis
Michiel
M
Stenlund
Hans
H
Bairaktaris
Andreas
A
Körfer
Reiner
R
D000293:Adolescent; D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007223:Infant; D007231:Infant, Newborn; D008297:Male
D007166:Immunosuppressive Agents