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Pediatric heart transplantation at Stanford: results of a 15-year experience
D Baum1, D Bernstein, V A Starnes
1Stanford University School of Medicine, California 94305.
Insights
Pediatric heart transplantation offers a viable option for children with end-stage heart disease, demonstrating significant long-term survival rates and reduced hospitalizations post-transplant.
Area of Science:
- Cardiology
- Pediatric Surgery
- Immunology
Background:
- Pediatric heart transplantation is a critical treatment for end-stage cardiac disease in children.
- Long-term outcomes and complications require continuous evaluation to optimize patient care.
Purpose of the Study:
- To evaluate the long-term results of pediatric heart transplantation.
- To assess survival rates, complications, and quality of life in young heart transplant recipients.
Main Methods:
- Retrospective analysis of 53 pediatric heart transplant recipients (0.25-18.94 years) at Stanford University Medical Center (1974-1989).
- Evaluation of indications, immunosuppression protocols (cyclosporine, prednisone, azathioprine), survival, rehospitalization rates, and causes of post-transplant mortality.
- Assessment of common complications including hypertension, renal dysfunction, and growth impairment.
Main Results:
- Cumulative survival rates were 79% at 1 year, 76% at 3 years, and 69% at 5 years, with 14 patients surviving over 5 years.
- Hospital readmissions decreased significantly over time, with 11 patients experiencing no rehospitalizations.
- Common causes of death included infection and rejection; hypertension and renal dysfunction were noted with cyclosporine use, and growth impairment with prednisone.
Conclusions:
- Pediatric heart transplantation is a reasonable alternative for carefully selected young patients with end-stage cardiac disease.
- Long-term survival is achievable, but careful management of immunosuppression and potential complications is essential.
- Further research into optimizing immunosuppression and managing long-term sequelae is warranted.
Abstract:
The long-term results of pediatric heart transplantation were evaluated in 53 patients, aged 0.25 to 18.94 years, who received transplants at Stanford University Medical Center between 1974 and 1989. Indications for transplantation were idiopathic cardiomyopathy (68%), congenital heart disease (21%), endocardial fibroelastosis (8%), and doxorubicin cardiomyopathy (3%). Immunosuppression was achieved with combinations of cyclosporine, prednisone, and azathioprine. Thirty-seven of 42 recipients leaving the hospital after transplantation were alive and in New York Heart Association class I at study's end. Cumulative survival was 79% at 1 year, 76% at 3 years, and 69% at 5 years. Fourteen recipients have survived more than 5 years (5.1 to 12.4 years). Hospital readmission for illness has been infrequent, decreasing from 6.8 days to 0.9 days per year over 5 years. Eleven patients have required no rehospitalization. Posttransplant deaths were due to infection (19%), rejection (4%), pulmonary hypertension (4%), coronary artery disease (2%), and lymphoproliferative disease (2%). Retransplantation was required for intractable rejection in 4 patients and advanced coronary artery disease in 2. Hypertension and elevated blood urea nitrogen and creatinine levels were common in individuals receiving cyclosporine. Growth was often impaired in prepubertal children receiving daily prednisone. Based on this 15-year experience, it is concluded that heart transplantation represents a reasonable alternative for selected young patients with end-stage cardiac disease.