Cor Vasa 2013, 55(4):e315-e319 | DOI: 10.1016/j.crvasa.2013.05.008

Pediatric heart transplantation: 17-year Brno experience

Marie Ošmerová, Petr Němec^*, Jan Černý

Centrum kardiovaskulární a transplantační chirurgie, Brno, Česká republika

Aim: To summarize the follow-up of children who underwent orthotopic heart transplantation (HTx) in the Center of Cardiovascular and Transplantation Surgery in Brno during the past 17 years.

Patients and methods: Between May 1995 and October 2012, 42 children aged 2 months-17.5 years were listed for HTx, of these 26 underwent HTx later.

Results: Of 42 children listed for HTx, 12 died, 26 underwent HTx, 3 were excluded because of improved clinical status, and 1 is waiting for HTx. Five children died early after the transplantation, one patient died 6.5 years after HTx. The 1-year, 5-year and 10-year post-transplantation survival rates are 81%, 81%, and 76.9%, respectively. One patient underwent re-transplantation 11.5 years after HTx because of coronary artery disease affecting the graft. Long-term follow-up data are available for 21 children surviving 1.6-17.4 years (mean 8.7 ± 5.3 years). The most common morbidities were hypertension and mild chronic kidney disease (CKD 2). Pneumonia was the most common infectious complication requiring hospitalization. EBV infection with subsequent development of post-transplant lymphoproliferative disorder (PTLD) was a severe late complication in two patients (diagnosed 8 and 15 years after transplantation). The increase in incidence of coronary artery disease during the second decade post-HTx (affecting 7.7% patients after 5 years and 42.8% patients after 10 years) leads to a significant increase in the morbidity of pediatric patients surviving more than 10 years after transplantation.

Conclusion: Heart transplantation currently represents an effective treatment of terminal heart failure in children. Improving outcomes of pediatric HTx mainly reflect the drop in early mortality. The main causes of late morbidity and mortality of children after HTx are the increase in incidence of coronary artery disease and malignant diseases (PTLD). Our results of long-term follow-up of children after heart transplantation are consistent with published data from other centers.

Keywords: Pediatric heart transplantation; Rejection; Cardiac allograft vasculopathy; Survival

Received: December 31, 2012; Revised: May 21, 2013; Accepted: May 22, 2013; Published: August 1, 2013  Show citation