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Cardiac transplantation for Kawasaki disease
P A Checchia1, E Pahl, R E Shaddy
1Division of Pediatric Critical Care Medicine, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois, USA.
Insights
Cardiac transplantation is a viable treatment for severe heart complications from Kawasaki disease, offering a positive outcome for most patients with irreversible heart damage. This procedure provides a life-saving option when other treatments fail.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Transplantation Medicine
Background:
- Kawasaki disease can lead to severe cardiac complications, including coronary ischemia.
- Coronary artery bypass procedures are common treatments, but some patients develop severe, irreversible heart damage.
- Cardiac transplantation is rarely reported for Kawasaki disease complications.
Purpose of the Study:
- To compile and analyze global data on cardiac transplantation in patients with Kawasaki disease.
- To evaluate the feasibility and outcomes of heart transplantation for Kawasaki disease sequelae.
Main Methods:
- Data collected from United Network for Organ Sharing Registry and European transplant databases.
- Information gathered via phone surveys with Kawasaki disease investigators.
- Review of diagnostic, surgical, and clinical records for identified patients.
Main Results:
- Ten patients with Kawasaki disease underwent cardiac transplantation; data analyzed for these cases.
- Transplantation timing varied from within 6 months to 9-12 years post-diagnosis.
- Indications included severe myocardial dysfunction, arrhythmias, and coronary artery disease.
- Nine of ten patients survived with positive outcomes up to 6 years post-transplant.
- One patient died from rejection; another required retransplantation.
Conclusions:
- Cardiac transplantation is a feasible and beneficial option for a select group of Kawasaki disease patients.
- This includes patients with distal coronary stenosis/aneurysms unsuitable for revascularization.
- It also benefits those with severe, irreversible myocardial dysfunction.
Objective:
Severe cardiac sequelae from Kawasaki disease include coronary ischemia and have been treated with a variety of coronary artery bypass procedures. There is only one published report of a child who underwent cardiac transplantation for severe Kawasaki disease-related cardiac complications. The purpose of this study was to gather the worldwide experience with cardiac transplantation for Kawasaki disease.
Methods:
Data were obtained from the United Network for Organ Sharing Registry, the European transplant experience, and a phone survey of many Kawasaki disease investigators. Diagnostic and surgical reports as well as clinical records were reviewed. Results. We identified 13 Kawasaki disease patients who underwent cardiac transplantation and obtained data on 10. In these 10 patients, the timing of transplantation was within 6 months after diagnosis of Kawasaki disease (4 patients), 1 to 5 years after diagnosis (3 patients), and 9 to 12 years after diagnosis (3 patients). Indications for transplantation included severe myocardial dysfunction, severe ventricular arrhythmias including cardiac arrest, and severe distal multivessel occlusive coronary artery disease. Nine of the 10 patients remain alive and healthy, with up to 6 years' posttransplant follow-up. One patient died 10 months posttransplant after severe refractory rejection. In addition, 1 patient required retransplantation at 4 years for severe rejection.
Conclusions:
Cardiac transplantation for severe ischemic heart disease as a sequela of Kawasaki disease is feasible and can benefit the small subgroup of patients who are not candidates for revascularization because of distal coronary stenosis or aneurysms and/or those with severe irreversible myocardial dysfunction.