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Early experience with pediatric cardiac transplantation in a limited resource setting
Swati Garekar1, Talha Meeran2, Vinay Patel1
1Division of Pediatric Cardiology, Fortis Hospital, Mumbai, Maharashtra, India.
Insights
Pediatric heart transplantation in India shows promising short-term survival rates. Careful monitoring for rejection and coronary vasculopathy is crucial for long-term success in these young patients.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Pediatric heart transplantation is a vital treatment for end-stage heart failure in children.
- Access to this procedure is limited in many developing countries due to logistical challenges.
Purpose of the Study:
- To evaluate the initial experience with pediatric heart transplantation in India.
- To assess the feasibility and early outcomes of this procedure in a resource-limited setting.
Main Methods:
- A retrospective chart review of pediatric patients undergoing heart transplantation.
- Data analysis included descriptive statistics such as mean, median, standard deviation, and range.
Main Results:
- Twenty pediatric heart transplants were performed between January 2016 and June 2019.
- One-year survival was 100%, with 15% mortality at last follow-up.
- Common morbidities included rejection (35%), hypertension, and coronary allograft vasculopathy.
Conclusions:
- Pediatric heart transplantation in India yields acceptable short-term outcomes.
- Close surveillance for significant rejection and coronary allograft vasculopathy is essential.
Background:
Pediatric heart transplantation is a now a well-established and standard treatment option for end stage heart failure for various conditions in children. Due to logistic issues, it is not an option for in most pediatric cardiac centres in the third world.
Aim:
We sought to describe our early experience in the current era in India.
Methods:
This is a short term retrospective chart review of pediatric patients who underwent heart transplantation at our centre. Mean/Median with standard deviation /range was used to present data.
Results:
Twenty patients underwent orthotopic heart transplant between January 2016 and June 2019. The median age at transplant was 12.4years (range 3.3 to 17.3 years). The median weight was 23.2kg (range 10-80kg). The mean donor/recipient weight ratio was 1.62± 0.84. The mean ICU stay was 12.1days. The mean follow up post transplant was 2.03± 0.97years (range 10 days-3.57years). The 1 month and the 1 year survival was 100%. Biopsies were positive for significant rejection in 7 patients (35%). At the time of last follow-up, 3 patients (15%) had expired. The major post transplant morbidities were mechanical circulatory support (n=3), hypertension with seizure complex (n=3), post transplant lympho-proliferative disorder (n=1), pseudocyst of pancreas (n=1), coronary allograft vasculopathy (n=3) and systemic hypertension (n=7). All surviving patients (n=17) were asymptomatic at last follow up.
Conclusion:
The results suggest acceptable short term outcomes in Indian pediatric patients can be achieved after heart transplantation in the current era. Significant rejection episodes and coronary allograft vasculopathy need careful follow up.
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