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Heart transplantation in children and young adults: early and intermediate-term results
D A Fullerton1, D N Campbell, S D Jones
1Department of Surgery, University of Colorado, Denver.
Insights
Pediatric cardiac transplantation for heart failure shows excellent short- and intermediate-term results. This study highlights successful outcomes in young patients with congenital heart disease and cardiomyopathy undergoing heart transplants.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Congenital heart disease and cardiomyopathy are leading causes of end-stage heart failure in pediatric and young adult populations.
- Cardiac transplantation is a critical intervention for patients with end-stage heart failure unresponsive to other treatments.
Purpose of the Study:
- To report short- and intermediate-term follow-up outcomes of cardiac transplantation in pediatric, adolescent, and young adult patients.
- To evaluate the efficacy and safety of cardiac transplantation for various etiologies of heart failure in this age group.
Main Methods:
- Retrospective analysis of 30 patients (8 months to 24 years) undergoing cardiac transplantation.
- Patients had diagnoses including congenital heart disease, dilated cardiomyopathy, and restrictive/hypertrophic cardiomyopathy.
- Immunosuppression involved antithymocyte globulin induction, followed by cyclosporine and azathioprine; rejection surveillance utilized echocardiographic criteria.
Main Results:
- Operative mortality was low at 3.3% (1/30).
- No cases of accelerated allograft atherosclerosis or posttransplantation lymphoproliferative disease were observed.
- Follow-up ranged from 3 to 78 months, demonstrating favorable outcomes.
Conclusions:
- Cardiac transplantation can be performed with excellent early and intermediate-term results in pediatric, adolescent, and young adult patients.
- The study supports cardiac transplantation as a viable and effective treatment option for end-stage heart failure in this demographic.
Abstract:
The purpose of this article is to report our short- and intermediate-term follow-up of cardiac transplantation for congenital heart disease and cardiomyopathy in children (age greater than 6 months), adolescents, and young adults. Thirty patients (ages 8 months to 24 years) with end-stage heart failure have undergone cardiac transplantation in our program: 12 (40%) for postoperative end-stage heart failure, 9 (30%) as primary treatment for congenital heart disease, 5 (17%) for dilated cardiomyopathy, and 4 (13%) for restrictive/hypertrophic cardiomyopathy. Nineteen patients (63%) had undergone prior operations; 4 patients received transplants for failed Fontan procedures. Induction therapy with antithymocyte therapy was used routinely, and long-term immunosuppression was by cyclosporine and azathioprine alone. Rejection surveillance/diagnosis was based on echocardiographic criteria. Posttransplantation follow-up ranges from 3 to 78 months. Operative mortality was 3.3% (1/30). No patients have been diagnosed with either accelerated allograft atherosclerosis or posttransplantation lymphoproliferative disease. We conclude that cardiac transplantation may be performed with excellent early and intermediate-term results.