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Published on: July 18, 2014
Pediatric Heart Transplant: Initial Experience in a Tertiary Center in Brazil
Francisco Candido Monteiro Cajueiro1, Ulisses Alexandre Croti1, Alexandra Regina Siscar Barufi1
1Pediatric Cardiology and Cardiovascular Surgery, CardioPedBrasil - Hospital da Criança e Maternidade de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil.
Insights
Pediatric heart transplantation offers a viable treatment for children with end-stage heart failure. This study highlights initial outcomes in Brazil, showing a 77.1% survival rate at 131 months.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Pediatric heart transplantation is the primary treatment for end-stage heart failure in children.
- This study details the initial pediatric heart transplantations performed at a tertiary center in Brazil.
Purpose of the Study:
- To describe the initial experience and outcomes of pediatric heart transplantation in Brazil.
- To evaluate the feasibility and effectiveness of this procedure in a pediatric population.
Main Methods:
- A historical prospective descriptive cohort study.
- Review of medical records of children undergoing heart transplantation between 2010 and 2020.
- Statistical analysis including Kaplan-Meier survival curves.
Main Results:
- Ten pediatric heart transplantations were performed, with 30% in infants under one year.
- High rates of end-stage heart failure (90%) and clinical deterioration (50%) were observed.
- The death-free survival rate at 131 months was 77.1±14.4%.
- Post-transplant complications included cytomegalovirus infection (88.9%) and cellular rejection (44.4%).
Conclusions:
- Pediatric heart transplantation is an acceptable and feasible therapy for children with end-stage heart failure.
- The initial experience demonstrates promising survival rates despite significant pre-transplant challenges.
Introduction:
Pediatric heart transplantation is the definitive therapy for children with end-stage heart failure. This paper describes our initial experience in pediatric heart transplantation in a tertiary center in Brazil.
Methods:
This is a historical prospective descriptive cohort study based on a review of the medical records of children undergoing heart transplantation at Hospital de Base and Hospital da Criança e Maternidade de São José do Rio Preto. Variables were displayed as frequency, mean, or median. Statistical analysis and Kaplan-Meier actuarial curve were obtained with the aid of Microsoft® Excel® 2019 and STATSDirect version 3.3.5.
Results:
Between January 2010 and December 2020, ten children underwent bicaval orthotopic heart transplantation, 30% of which were under one year of age. Nine patients had end-stage heart failure (International Society for Heart and Lung Transplantation-Heart Failure D) and 50% of the recipients were transplanted under conditions of progressive clinical deterioration (Interagency Registry for Mechanically Assisted Circulatory Support ≤ 2). Forty percent of the recipients had a panel-reactive antibody > 20% on virtual crossmatch. In the postoperative period, 80% of patients required high dose of inotropic support (vasoactive-inotropic score > 10) for > 48 hours. The death-free survival rate at 131 months was 77.1±14.4%. Most patients (88.9%) in late follow-up had an episode of active cytomegalovirus infection. Cellular rejection, with or without clinical repercussion, was present in 44.4% of the patients.
Conclusion:
Pediatric heart transplantation produces acceptable and feasible outcomes as definitive therapy for children with end-stage heart failure.
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