Intermediate and long-term results after pediatric heart transplantation: incidence and role of pretransplant diagnosis

Abstract

From November 1985 to 31 July 1997, 65 pediatric patients underwent heart transplantation at Bambino Gesù Hospital in Rome. Two of them underwent retransplantation, both 6 years after the first transplant. The 67 transplant patients had a mean age of 59 months; 11 were under 1 year of age. Their indications for transplantation were cardiomyopathies (38), lymphocytic myocarditis (8), and congenital heart diseases (19). Two patients of the first group successfully received a combined heart and kidney transplant. The 1-, 5-, and 11-year actuarial survival rates for the 65 patients who underwent heart transplantation were 68%, 62%, and 42%, respectively. In the 1st postoperative year in patients who had had cardiomyopathy, a total of 50 episodes of acute rejection (AR), with one death, occurred (mean 1.7 AR/patient per year +/- 1.5) and, in patients who had had congenital heart diseases, 19 ARs (one death) occurred with a mean of 1.58 AR/patient per year +/- 1.4. The incidence of AR was significantly higher in patients who had had myocarditis with a total of 26 episodes (mean 3.7 AR/patient per year +/- 2) and one death. Rehabilitation of heart transplanted children and infants was complete (NYHA class 1) in 52% of patients of this series. We conclude that heart transplantation may give a good intermediate and long-term survival in selected patients; the extension of indications to desperately ill patients, or patients with systemic diseases or complex congenital heart diseases may bring less encouraging results, but should not be definitely excluded. Scarcity of donors remains the main limit, being still the first cause of death for patients on our waiting list. Our limited experience seems to suggest that, as described in adults, the cellular amplification of the immune response might affect the post-heart transplant follow up of pediatric patients with myocarditis resulting in a poor outcome for this population.

Pediatric cardiac transplant: Results using a steroid‐free maintenance regimen

“…This study shows that good survival figures are achievable without the use of long‐term steroids. Actuarial survival compares favourably with data from the Registry of the International Society of Heart and Lung Transplantation (1, 2) and other centres where steroids are used in some (5–8, 14, 15) or all (10) children and results at 1, 5 and 10 yr range from 58–80%, 60–70% and 42–66%, respectively. Other authors also have demonstrated excellent actuarial survival of 80, 76 and 76% at 1, 5 and 10 yr (16) and 79 and 69% at 1 and 5 yr (17) using a steroid‐free regimen.…”

“…The larger multi‐centre reports give an excellent overall picture of contemporary pediatric heart transplantation (1–4) but do not allow comparison between the different management regimens, which vary between centres. Many centres use an immunosuppressive maintenance regimen including steroids for some (5–9) or all (10) of the children.…”