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Heart, heart-lung, and lung transplantation in the first year of life
V A Starnes1, P E Oyer, D Bernstein
1Department of Cardiothoracic Surgery, Stanford University Medical Center, California 94305.
Insights
Infant heart, heart-lung, and lung transplants show promising survival rates and lower rejection compared to older children. These pediatric organ transplant procedures demonstrate clinical efficacy in infants with end-stage cardiopulmonary disease.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Transplant Immunology
Background:
- End-stage cardiopulmonary disease in infants presents significant challenges.
- Infant organ transplantation is a complex but potentially life-saving intervention.
- Limited data exists on the outcomes of heart, heart-lung, and lung transplantation in infants.
Purpose of the Study:
- To evaluate the clinical efficacy and outcomes of heart, heart-lung, and lung transplantation in infants.
- To compare survival rates and rejection episodes in infants versus older children.
- To assess intermediate outcomes, including graft atherosclerosis and obliterative bronchiolitis.
Main Methods:
- Retrospective analysis of 17 infants (<1 year) undergoing heart, heart-lung, or lung transplantation.
- Data collection on diagnoses, age, transplant type, survival, rejection rates, immunosuppression protocols, and complications.
- Actuarial survival analysis and comparison with historical data from older children.
Main Results:
- Actuarial survival at 1 and 2 years was 74%, comparable to older children (82% and 69%).
- Infants exhibited a significantly lower linearized rejection rate (0.61 vs. 1.48 episodes/100 patient days).
- No graft atherosclerosis was observed; 3/5 infants in heart-lung/lung transplant group survived with good outcomes.
Conclusions:
- Heart, heart-lung, and lung transplantation are clinically effective in infants with end-stage cardiopulmonary disease.
- Infants demonstrate favorable survival and reduced rejection post-transplant compared to older pediatric populations.
- Further research into optimizing immunosuppression and managing complications in infant transplantation is warranted.
Abstract:
Seventeen infants less than 1 year of age have undergone heart (12), heart-lung (3), and lung (2) transplantation for end-stage cardiopulmonary disease. The infants undergoing heart transplantation had a mean age of 4.5 months (range, 19 days to 12 months) with the diagnosis of cardiomyopathy in 4 and congenital heart disease in 8. Four of the 8 patients (50%) had hypoplastic left heart syndrome. Actuarial survival at 1 and 2 years was 74% and compared favorably with the survival of older children at 1 and 2 years of 82% and 69%. The linearized rejection rate was less in infants as compared with children more than 1 year of age (0.61 versus 1.48 episodes per 100 patient days). In intermediate follow-up, no graft atherosclerosis has been noted. Immunosuppression has included a three-drug protocol of cyclosporine, azathioprine, and prednisone. A steroid taper to alternate day steroids or off completely by 6 months has been the goal and has been accomplished in 6 of 12 infants. Heart-lung and lung transplantation has been performed in 5 infants. One infant in each group died: 1 infant secondary to airway complications and sepsis and another due to pulmonary sepsis. A pulmonary lobe from a larger and older donor was transplanted into a 4-week-old infant as a single-lung transplant with good outcome. The 3 surviving infants are well 24, 18, and 2 months after transplantation. Obliterative bronchiolitis has not been clinically apparent in this group. These data support the clinical efficacy of heart, heart-lung, and lung transplantation in the first year of life.