[Heart transplantation in childhood]

Area of Science:

• Cardiology
• Pediatric Surgery
• Immunology

Context:

• End-stage heart failure in children presents significant challenges.
• Orthotopic heart transplantation is a viable treatment option for pediatric patients.
• Dilative cardiomyopathy, tricuspid atresia, and hypoplastic left-heart syndrome are common etiologies.

Purpose:

• To evaluate the outcomes of orthotopic heart transplantation in pediatric patients.
• To assess survival rates and complications following heart transplantation in children.
• To analyze the efficacy of standard immunosuppressive therapy in pediatric heart recipients.

Summary:

• Nine pediatric patients (3 months–18 years) with end-stage heart failure underwent orthotopic heart transplantation.
• Postoperative immunosuppression utilized a combination of cyclosporine A, azathioprine, and prednisolone.
• Seven patients (77.7%) were catecholamine-dependent pre-transplant.
• Rejection was monitored via endomyocardial biopsy, intramyocardial electrogram, echocardiography, and cytoimmunological monitoring.
• Seven of nine patients survived with favorable rehabilitation after a mean follow-up of 29 months.
• Two patients experienced graft failure; one developed chronic cyclosporine A toxicity requiring kidney transplantation.

Impact:

• Heart transplantation significantly improves survival rates in critically ill children and adolescents.
• The procedure demonstrates favorable physical and social rehabilitation, supporting its continued application.
• Outcomes in pediatric heart transplantation mirror those in adult populations.
• This study encourages further research and application of heart transplantation in pediatric care.