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Updated: Aug 18, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Ten year survival after paediatric heart transplantation: a single centre experience
Rosemary Radley Smith1, Jo Wray, Asghar Khaghani
1Royal Brompton, Harefield NHS Trust, Paediatric Surgical Unit, Harefield Hospital, Harefield, Middlesex UB9 6JH, UK. r.radley-smith@rbh.nthames.nhs.uk <r.radley-smith@rbh.nthames.nhs.uk>
Insights
Pediatric heart transplantation survival is improving, with over half of one-year survivors reaching 10 years. Key challenges for long-term pediatric heart transplant recipients include adherence and declining renal function.
Area of Science:
- Pediatric Cardiology
- Transplantation Medicine
- Immunology
Background:
- Pediatric heart transplantation is a critical treatment for end-stage heart failure in children.
- Long-term outcomes and survival rates in pediatric heart transplant recipients require ongoing evaluation.
Purpose of the Study:
- To assess the 10-year survival rates of children under 16 who underwent heart transplantation.
- To identify factors influencing long-term outcomes in this pediatric population.
Main Methods:
- Retrospective analysis of 193 pediatric heart transplant recipients.
- Survival data analyzed, focusing on 1-year and 10-year post-transplant milestones.
- Graft coronary disease and renal function monitored via coronary angiography and serum creatinine levels.
Main Results:
- 73% survived beyond 1 year, and 53% of those reached over 10 years post-transplant.
- Graft coronary disease affected 11% of patients; post-transplant lymphoproliferative disease (PTLD) occurred in 7 patients.
- Deteriorating renal function and end-stage renal failure were observed in a significant number of long-term survivors.
Conclusions:
- Ten-year survival following heart transplantation is achievable for pediatric patients.
- Patient adherence and the management of renal function are critical challenges for long-term success in pediatric heart transplant recipients.
Objective:
To report 10 years survival in children under the age of 16 years undergoing heart transplantation in a single institution.
Methods:
One hundred and thirty nine/one hundred and ninety three patients (73%) survived more than 1 year after transplant. Seventy four (53%) of these survived more than 10 (10.0-20.1) years. Age at operation was 10 days-15.5 (mean 8.1) years. Patients were maintained on ciclosporin and azathiaprine alone. Routine steroids only given to 4 patients for either persistent rejection or deteriorating renal function. Rejection diagnosed on clinical or echocardiographic grounds. No routine biopsies were performed. Bi-annual coronary angiography was used to diagnose graft coronary disease.
Results:
Graft coronary disease was found in 8 patients (11%), 2 were re-transplanted and have survived 4.3-7.2 years since. Two patients are alive without intervention 2.0-13.0 years from initial diagnosis. Two patients have undergone interventional procedures 11 and 16 years after transplantation and are alive 3 and 4 years, respectively, later. Seven patients have had post transplant lymphoproliferative disease (PTLD) and 6 have had no recurrence for 3-13 years after treatment. Impaired renal function with abnormal serum creatinine levels is increasingly common-11 patients have developed end stage renal failure, 7 requiring renal transplantation, hypertension occurred in only 3 patients other than those in renal failure. Late rejection episodes associated with probable non-adherence occurred in 7 patients. There were 10 late deaths; 2 from graft coronary disease; 1 from PTLD; 3 from renal failure; 3 from acute rejection and 1 from infection. Conditional actuarial survival from 1 year post transplant was 76 and 67% at 10 and 15 years, respectively.
Conclusions:
Survival for more than 10 years is increasingly realistic. In this age group adherence and deteriorating renal function are major challenges.
