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Pediatric heart transplantation without chronic maintenance steroids
P Ferrazzi1, R Fiocchi, A Gamba
1Department of Cardiac Surgery, Ospedali Riuniti di Bergamo, Italy.
Insights
Pediatric heart transplantation achieved an 88% 5-year survival rate, with no deaths from rejection or infection. This study highlights successful outcomes in young heart transplant recipients.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Immunosuppression Therapy
Background:
- Heart transplantation in children is a critical treatment for end-stage heart failure.
- Indications vary, including cardiomyopathy and congenital heart disease.
- Optimizing immunosuppression and managing complications are key challenges.
Purpose of the Study:
- To evaluate the outcomes of pediatric heart transplantation.
- To assess survival rates, rejection episodes, infections, and long-term complications.
- To analyze growth and graft atherosclerosis in pediatric recipients.
Main Methods:
- Retrospective analysis of 40 pediatric heart transplant recipients (aged 2 months to 18 years) from 1986 to 1993.
- Management with cyclosporine and azathioprine, with selective steroid use for rejection.
- Monitoring included noninvasive methods for younger children, annual catheterizations, and growth assessments.
Main Results:
- Overall 5-year survival was 88%, with no deaths attributed to rejection or infection.
- Rejection treatment was common in the first postoperative month (89%).
- Graft atherosclerosis was not observed; growth was not impaired compared to controls. Seizures and hypertension were noted in some patients.
Conclusions:
- Pediatric heart transplantation demonstrates favorable long-term survival and acceptable complication rates.
- Current immunosuppressive strategies appear effective in preventing fatal rejection and infection.
- Further research on long-term graft health and neurodevelopmental outcomes is warranted.
Abstract:
From 1986 to February 1993, 40 children aged 2 months to 18 years (average age 10.4 +/- 5.8 years) underwent heart transplantation. Indications for transplantation were idiopathic cardiomyopathy (52%), congenital heart disease (35%) with and without prior repair (71% and 29%, respectively), hypertrophic cardiomyopathy (5%), valvular heart disease (3%), and doxorubicin cardiomyopathy (5%). Patients were managed with cyclosporine and azathioprine. No prophylaxis with antilymphocyte globulin was used. Steroids were given to 39% of patients for refractory rejection, but weaning was always attempted and generally successful (64%). Five patients (14%) received maintenance steroids. Four patients died in the perioperative period and one died 4 months later. There have been no deaths related to rejection or infection. Average follow-up was 36 +/- 19 months (range 1 to 65 months). Cumulative survival is 88% at 5 years. In patients less than 7 years of age, rejection was monitored noninvasively. In the first postoperative month, 89% of patients were treated for rejection. Freedom from serious infections was 83% at 1 month and 65% at 1 year. Cytomegalovirus infections were treated successfully with ganciclovir in 11 patients. No impairment of growth was observed in children who underwent transplantation compared with a control population. Twenty-one patients (60%) have undergone annual catheterizations and no sign of graft atherosclerosis has been observed. Seizures occurred in five patients (14%) and hypertension was treated in 10 patients (28%). No patient was disabled and no lymphoproliferative disorder was observed.(ABSTRACT TRUNCATED AT 250 WORDS)