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[Heart and heart-lung transplantation in the child. Indications, methods and results]
J Kachaner1, J Le Bidois, D Sidi
1Service de Cardiologie Pédiatrique, Groupe Hospitalier Necker/Enfants-Malades/Laënnec, Paris.
Insights
Pediatric heart transplantation offers a viable treatment for severe heart conditions, though heart-lung transplants are more complex. Survivors require ongoing immunosuppression and monitoring but can lead normal lives.
Area of Science:
- Cardiology
- Pediatric Surgery
- Immunology
Context:
- A 20-month study involving 19 pediatric patients (13 days to 15 years) undergoing heart or heart-lung transplantation.
- High mortality rate (44%) observed, with early deaths occurring within the first three postoperative months.
Purpose:
- To evaluate the feasibility and outcomes of heart and heart-lung transplantation in pediatric patients.
- To assess the long-term quality of life for survivors of pediatric heart transplantation.
Summary:
- 16 isolated heart transplants and 3 heart-lung transplants were performed.
- 8 of 9 survivors are living normal lives with oral immunosuppression (cyclosporin-azathioprine) and monthly outpatient follow-ups.
- Transplant dysfunction and infections were primary causes of failure, necessitating rigorous patient and donor selection.
Impact:
- Pediatric heart transplantation is a viable, albeit complex, option for severe cardiac conditions unresponsive to conventional therapies.
- Heart-lung transplantation presents greater challenges compared to isolated heart transplantation.
- Long-term survival and quality of life are achievable with appropriate management and selection criteria.
Abstract:
Over a 20 month period, 19 children aged 13 days to 15 years (10 under 3 years), received a heart transplantation (isolated: 16 cases, heart-lungs: 3 cases). There were 5 early deaths and 2 during the 3rd postoperative month (total: 44%). Postoperative period is currently over for 8 of the 9 survivors, who lead a normal life, with rather simple constraints: oral cyclosporin-azathioprine immunosuppressive therapy, monthly evaluation in the out-patient department. The method is relatively simple when it concerns heart transplantation. It is quite heavier and complex when it concerns heart-lung transplantation. On the whole, subject to a rigorous selection of the transplant (whose later dysfunction was the major cause of failure, with bacterial or viral infections), these methods find reasonable indications in a number of heart and/or lung malformations or dysfunctions inaccessible to conventional treatments or which used up their resources, making short-term death likely.
