Pediatric and congenital heart transplant: twenty-year experience in a tertiary Brazilian hospital.
BACKGROUND
Cardiac transplantation remains the gold standard for end-stage cardiomyopathies and congenital heart defects in pediatric patients.


OBJECTIVE
This study aims to report on 20 years of experience since the first case and evaluate our results.


METHODS
We conducted a retrospective analysis of the database and outpatient follow-up. Between October 1992 and April 2012, 109 patients underwent 114 transplants. 51.8% of them being female. The age of patients ranged from 12 days to 21 years with a mean of 8.8±5.7 years and a median of 5.2 years. The underlying diagnosis was dilated cardiomyopathy in 61.5%, congenital heart disease in 26.6% and restrictive cardiomyopathy in 11.9%. All patients above 17 years old had congenital heart disease.


RESULTS
Survival rate at 30 days, 1, 5, 10, 15, and 20 years were 90.4%, 81.3%, 70.9%, 60.5%, 44.4% and 26.7%, respectively. Mean cold ischemic time was 187.9 minutes and it did not correlate with mortality (P>0.05). Infectious complications and rejection episodes were the most common complications (P<0.0001), occurring, respectively, in 66% and 57.4% of the survivors after 10 years. There was no incidence of graft vascular disease and lymphoproliferative disease at year one, but they affected, respectively, 7.4% and 11% of patients within 10 years.


CONCLUSIONS
Twenty-year pediatric heart transplant results at our institution were quite satisfactory and complication rates were acceptable.
InCor, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
Leonardo Augusto
LA
Miana
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Estela
E
Azeka
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Luiz Fernando
LF
Canêo
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Aída Luisa
AL
Turquetto
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Carla
C
Tanamati
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Juliano Gomes
JG
Penha
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Alexandre
A
Cauduro
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Marcelo Biscegli
MB
Jatene
D000293:Adolescent; D017677:Age Distribution; D001938:Brazil; D009202:Cardiomyopathies / Q000601:surgery*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection; D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult