title: Adaptive growth and remodeling of transplanted hearts in children.
abstract: OBJECTIVE
  We aimed to evaluate the adaptive growth and remodeling behavior of the transplanted heart in pediatric heart-transplant recipients by comparing donor body surface area (BSA) and cardiac dimensions during transplantation with the corresponding parameters of the recipient over a period of time.
  
  
  METHODS
  A retrospective review of medical and echocardiographic records of 167 children (8.65 ± 5.98, median 9; range 0-17 years) who underwent orthotopic heart transplantation between 1987 and March 2010 was done.
  
  
  RESULTS
  In the first 30 days post-transplantation, right- and left-ventricular end-diastolic diameters, volumes, and myocardial mass were found to be significantly increased (z score 3.96, p < 0.000) in relation to the recipients' BSA. Within the first year of post-transplantation, there was a significant reduction in the right-ventricular diameter (z score, -1.0 to +1.6, p = 0.000), left-ventricular diameter (z score -1.0 to +1.9, p = 0.000), right-ventricular end-diastolic volume (z score -1.3 to +1.9, p = 0.000) and left-ventricular end-diastolic volume (z score -1.3 to +1.8, p = 0.000), right-ventricular mass (z score, -1.4 to +1.7, p = 0.000) and left-ventricular mass (z score, -1.4 to +1.8, p = 0.000). During subsequent follow-up periods of 2-5 and 6-10 years, the aforementioned cardiac dimensions and volumes increased appropriately in accordance to the BSA (p = 0.000). In all the cardiac dimensions and volumes measured, donor-recipient mismatch did not influence the continuous growth of the measured parameters, which was in accordance to the recipients' BSA over time. Kaplan-Meier survival analysis showed a survival rate of 61.7% at 10 years. There is no statistically significant difference in survival rate among patients with varying donor-recipient weight ratios and donor-recipient BSA ratios (p = 0.53).
  
  
  CONCLUSIONS
  This study demonstrates that the transplanted heart undergoes remodeling processes and grows adaptively, in accordance to the BSA, over a period of time.
authors: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. delmo-walter@dhzb.de
authors: Eva Maria
authors: EM
authors: Delmo Walter
authors: Michael
authors: M
authors: Huebler
authors: Christof
authors: C
authors: Stamm
authors: Vladimir
authors: V
authors: Alexi-Meskishvili
authors: Yuguo
authors: Y
authors: Weng
authors: Felix
authors: F
authors: Berger
authors: Roland
authors: R
authors: Hetzer
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology; D000293:Adolescent; D001830:Body Surface Area; D002648:Child; D002675:Child, Preschool; D005260:Female; D006321:Heart / Q000033:anatomy & histology / Q000254:growth & development*; D016027:Heart Transplantation / Q000502:physiology*; D006352:Heart Ventricles / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007223:Infant; D008297:Male; D009929:Organ Size; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D014463:Ultrasonography; D020257:Ventricular Remodeling / Q000502:physiology