[Practical aspects in the surveillance of heart and heart-lung grafts in children]

The short and middle term survivors of the 19 transplanted children (heart and heart-lungs) of our program are treated with an association of cyclosporine and azathioprine. The detection of rejection is the main worry and relies on endomyocardial biopsy, but this investigation may be dangerous and lowers the available veins of smaller children. Thus, we use it only for the situations of clinical suspicion (18 times in 20 months in 8 children, which proved rejection 6 times in 3 patients). Renal function supervision is careful and comprises systematic renal biopsy; tubulo-interstitial lesions were constant: minimal 3 times, moderate 3 times. This prompts to prescribe the lowest possible cyclosporine dosages which ensure an effective residual blood level (100-300 ng/ml). In case of heart-lung transplantation (3 cases), pulmonary rejection is difficult to prove, opportunistic infections more frequent and severe, and the tracheal suture is responsible for complications (stenosis in 2 cases). By and large, the constraints of supervision are reasonable and allow an almost normal life.