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Thoracic organ transplantation in the paediatric age group. The Hannover experience
A Haverich1, S W Hirt, I Wagenberth
1Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.
Insights
Pediatric thoracic organ transplantation offers hope for children with severe heart and lung disease. While lung transplant survival remains challenging, isolated heart transplants show excellent long-term outcomes with proper immunosuppression.
Area of Science:
- Pediatric cardiothoracic surgery
- Organ transplantation
- Immunosuppression protocols
Background:
- Thoracic organ transplantation is a viable treatment for pediatric end-stage cardiopulmonary diseases.
- Indications include dilated cardiomyopathy, myocardial failure, cystic fibrosis, pulmonary hypertension, and congenital heart defects.
Purpose of the Study:
- To review the outcomes of pediatric thoracic organ transplantation.
- To assess survival rates and long-term graft function in pediatric heart, heart-lung, and lung transplant recipients.
Main Methods:
- Retrospective analysis of pediatric thoracic organ transplant cases.
- Evaluation of early and long-term survival, immunosuppression strategies, and potential complications.
Main Results:
- 20 heart, 4 heart-lung, 2 single lung, and 1 double lung transplant performed in pediatric patients.
- High early mortality (50%) for lung and heart-lung transplants.
- Excellent 6-year survival (79%) for isolated cardiac transplants with triple drug immunosuppression.
- No significant impairment in renal function, blood pressure, growth, or rehabilitation post-cardiac transplant.
- Graft atherosclerosis absent in cardiac allografts at 5 years; obliterative bronchiolitis data lacking for lung transplants.
Conclusions:
- Isolated pediatric cardiac transplantation demonstrates excellent long-term results.
- Lung and heart-lung transplantation in children face high early mortality.
- Management of chronic rejection is crucial for long-term survival and quality of life in pediatric thoracic transplant recipients.
Abstract:
Growing experience in terms of immunosuppression, recipient and donor selection as well as organ preservation has established thoracic organ transplantation as a therapeutic option for many children with end-stage cardiopulmonary diseases. While dilated cardiomyopathy and isolated myocardial failure represent the main indications for cardiac transplantation, replacement of the lungs or heart and lungs is necessitated in cystic fibrosis, primary and secondary pulmonary hypertension as well as some types of complex congenital heart defects involving the pulmonary arteries. We have performed a total of 20 heart, 4 heart-lung, 2 single lung and 1 double lung transplantation in the paediatric group up to 17 years of age. While with respect to the limited experience worldwide, early mortality after lung and heart-lung transplantation is still high (50%), long-term results in isolated cardiac transplantation using triple drug immunosuppression are excellent (79% survival after 6 years) without major impairment of renal function, arterial blood pressure, growth development and physical rehabilitation as well as social reintegration. Freedom from graft atherosclerosis of the allografted heart is documented over a 5 year follow up, while no data are available on the incidence of obliterative bronchiolitis after lung transplantation in the paediatric group. Despite only limited evidence of long-term dysfunction, diagnosis and prevention of chronic rejection should be given utmost attention to allow for a normal life span in this younger age group.