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Cardiac transplantation in children and adolescents
1Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York.
Insights
Pediatric cardiac transplantation is a viable treatment for children with severe heart conditions. This study shows that most children who received heart transplants experienced excellent long-term health outcomes.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Immunology
Background:
- Cardiac transplantation is a critical intervention for children with end-stage heart failure.
- Evaluating the outcomes of pediatric heart transplantation is essential for refining treatment protocols.
Purpose of the Study:
- To assess the feasibility and outcomes of cardiac transplantation in a pediatric population.
- To evaluate the efficacy of immunosuppressive therapy and rejection monitoring in pediatric heart transplant recipients.
Main Methods:
- A cohort of 22 children underwent evaluation for cardiac transplantation between 1984 and 1986.
- Fifteen children received transplants for cardiomyopathy or congenital heart disease, with immunosuppression using cyclosporine and prednisone.
- Rejection was monitored via endomyocardial biopsy, and patient outcomes were tracked post-transplant.
Main Results:
- Eleven of the 15 transplanted children survived long-term (up to 2 years), demonstrating excellent clinical health and activity levels.
- Early mortality included one intraoperative death and three early deaths (two from infection, one from rejection).
- Four children died while awaiting donor organs.
Conclusions:
- Pediatric cardiac transplantation is a valid and effective treatment option for children with end-stage heart disease.
- Successful outcomes in pediatric heart transplantation are achievable with appropriate immunosuppression and vigilant monitoring.
- Further research and experience from multiple institutions support the role of cardiac transplantation in improving survival and quality of life for pediatric patients.
Abstract:
Between June 1984 and October 1986, we evaluated 22 children for possible cardiac transplantation at Columbia-Presbyterian Medical Center. Four children died awaiting donor organs. Fifteen children received transplants; eight had cardiomyopathy, and seven had congenital heart disease. One child received a heterotopic transplant because of extremely high pulmonary vascular resistance. Immunosuppressive therapy consisted of 4 to 40 mg/kg/d cyclosporine and 0.2 to 0.5 mg/kg/d prednisone. Rejection was detected by the presence of myocyte necrosis in surveillance endomyocardial biopsy specimens. There were one intraoperative and three early deaths, two from infection and one rejection. The 11 survivors are observed from a few weeks to more than 2 years after transplantation, and all are in excellent clinical health and participate in age-appropriate activities. These data corroborate the experience of other institutions that cardiac transplantation is a valid treatment in children.