Results of pediatric cardiac transplantation - Long-term results of a 15-year experience

Introduction: Heart transplantation (HTx) has increasingly become a therapeutic option for end-stage heart failure of any origin in children. Short- and mid-term results are promising. However, long-term outcome has been a matter of concern because of acute or chronic rejection and side effects of immunosuppression. We performed a retrospective study of up to 15-years of follow-up on this patient entity. Methods: Between 1988 and 2004, 58 HTx were performed in 55 children (cardiomyopathy (DCM) 32, congenital heart disease (CHD) 23, Re-HTx 3). Mean age was 9.1 +/- 7.2 years (4 days - 17.9 years). Twenty-nine patients had a total of 51 previous operations. Results: Operative mortality was 4/58 (6.8%) due to primary graft failure. Late mortality was 7/54 (12.1%) due to acute rejection (2), pneumonia (2), intracranial hemorrhage (1), suicide (1) and lymphoma (1). Mean followup was 5.2 +/- 4.2 years. One-, 5-, and 10-year survival was 86%, 80% and 80%, respectively, and improved significantly after 1995 (92% and 92%; p = 0.04). Survival was comparable for DCM and CHD patients (1-year: 88% vs. 82%; p = 0.19; 5-years: 84% vs. 77%; p = 0.12). Three patients with therapy resistant rejection and assisted circulation required retransplantation and are alive. Freedom from acute rejection was 46% with primary cyclosporine immunosuppression and 63% with tacrolimus. Ninety-eight percent of the survivors are at home and in excellent cardiac condition. Conclusion: Pediatric heart transplantation is a curative treatment for DCM and CHD with excellent clinical mid-term results. However, further follow-up is necessary to evaluate long-term side effects of immunosuppressants. Donor shortage remains a problem.