Abstract
From 1987 to 1991, heart transplantation was undertaken in 49 infants and children with either end-stage cardiomyopathies (28 patients) or severe congenital heart disease (21 patients including 16 having already been surgically but unsuccessfully treated). Their age ranged from 13 days to 15 years (mean=4.5±4.2 years; median=2.5 years). There were 12 early and 7 late deaths (overall mortality=38%), mainly due to graft dysfunction, acute or chronic rejection, and infectious complications, mostly viral. Optimal criteria in selecting both donors and recipients are crucial to reduce early mortality and should never be transgressed despite the critical shortage of organs. The actuarial probability of survival was 64% at 1 year and 57% at 5 years. Our 30 mid-term survivors (62%) were submitted to a close follow up programme which includes endomyocardial biopsies, even in the very young, since non invasive criteria failed to mark every rejection episode. Maintenance therapy was always steroid-free to start with (cyclosporin + azathioprine) but in almost one half of our oldest survivors, it failed to avoid rejection and we had to add lowdose oral steroids for at least several months. Epstein-Barr virus related lymphoproliferations occurred in four patients, two of whom died and two recovered with specific therapy. Renal function was closely monitored: tubular and interstitial lesions were found on renal biopsies and were associated with moderate functional changes. The quality of life of the children who survived heart transplantation was considered as near normal in a little more than one half of the cases but many issues (late coronary disease, drug toxicity, long-term compliance to follow up and therapy) remain significant concerns for the future.
Similar content being viewed by others
References
Addonizio LJ, Hsu DT, Fuzesi L, Smith CR, Rose EA (1989) Optimal timing of pediatric heart transplantation. Circulation 80 [Suppl III]:84–89
Bailey L, Concepcion W, Shattuck H, Huang L (1986) Method of heart transplantation for treatment of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 91:1–5
Bailey LL, Nehlsen-Canarella SL, Doroshow RW, Jacobson JG, Martin RF, Allard MW, Hyde MR, Dang Bui RH, Petry EL (1986) Cardiac allotransplantation in newborns as therapy for hypoplastic left heart syndrome. N Engl J Med 315:949–951
Boucek MM, Kanakriyeh MS, Mathis CM, Trimm RF, Bailey LL (1990) Cardiac transplantation in infancy: donors and recipients. J Pediatr 116:171–176
Braunlin EA, Canter CE, Olivaria MT, Ring WS, Spray TL, Bolman RM (1990) Rejection and infection after pediatric cardiac transplantation. Ann Thorac Surg 49:385–390
Fischer A, Blanche S, Le Bidois J, Bordigoni P, Garnier JL, Niaudet P, Morinet F, Le Deist F, Fischer AM, Griscelli C, Hirn M (1991) Anti-B-cell monoclonal antibodies in the treatment of severe B-cell lymphoproliferative syndrome following bone marrow and organ transplantation. N Engl J Med 324: 1451–1456
Gersony WM (1990) Cardiac transplantation in infants and children. J Pediatr 116:266–268
Kachaner J, Le Bidois J, Sidi D, Vouhé P, Neveux JY, Touati G (1988) Transplantations cardiaques et cardio-pulmonaires chez l'enfant. Indications, méthodes et résultats. Arch Fr Pédiatr 45:727–733
Kriett JM, Kaye MP (1990) The Registry of the International Society for Heart Transplantation: seventh official report-1990. J Heart Transplant 9:323–330
Le Bidois J, Guarnera S, Sluysmans T, Vohé P, Sidi D, Kachaner J, Neveux JY (1988) Aspect pratique de la surveillance des greffes cardiaques et cardiopulmonaires chez l'enfant. Arch Fr Pédiatr 45:755–759
Le Bidois J, Niaudet P, Habib R, Sidi D, Villain E, Vouhé P, Kachaner J (1989) Renal function and pathology in infants and children treated with ciclosporine after heart transplantation. Third World Congress Pediatric Cardiology, Bangkok, 28 November–1 December 1989, pp 135–136
Lower RR, Shumway NE (1960) Studies on orthotopic homotransplantation of the canine heart. Surg Forum 11:18–20
Mayer JE, Perry S, O'Brien P, Perez Atayde A, Jonas RA, Castaneda AR, Parness IA (1990) Orthotopic heart transplantation for complex congenital heart disease. J Thorac Cardiovasc Surg 99:484–492
Pahl E, Fricker FJ, Armitage J, Griffith BP, Taylor S, Uretsky, BF, Beerman LB, Zuberbuhler JR (1990) Coronary arteriosclerosis in pediatric heart transplant survivors: limitation of long-term survival. J Pediatr 116:177–183
Pennington DG, Sarafian J, Swartz M (1985) Heart transplantation in children. J Heart Transplant 4:441–445
Starnes VA, Stinson EB, Oyer PE, Valantine H, Baldwin JC, Hunt SA, Shumway NE (1987) Cardiac transplantation in children and adolescents. Circulation 76 [Suppl V]:43–47
Starnes VA, Bernstein D, Oyer PE, Gamberg PL, Miller JL, Baum D, Shumway NE (1989) Heart transplantation in children. J Heart Transplant 8:20–26
Trento A, Griffith BP, Fricker FJ, Kormos RL, Armitage J, Hardesty RL (1989) Lessons learned in pediatric heart transplantation. Ann Thorac Surg 48:617–623
Vouhé PR, Tamisier D, Leca F, Le Bidois J, Khoury W, Mauriat P, Pouard P, Sidi D, Kachaner J, Neveux (1991) Heart transplantation in children: risk factors of early and late mortality. Eur J Cardiothorac Surg 5:176–182
Vouhé PR, Le Bidois J, Tamisier D, Sidi D, Leca F, Kachaner J (1992) Pediatric heart transplantation: surgical problems in recipients with congenital heart malformations. XXVIII Annual General Meeting Association European Pediatric Cardiology Berlin, 22–28 April
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Le Bidois, J., Kachaner, J., Vouhé, P. et al. Heart transplantation in children: Mid-term results and quality of life. Eur J Pediatr 151 (Suppl 1), S59–S64 (1992). https://doi.org/10.1007/BF02125805
Issue Date:
DOI: https://doi.org/10.1007/BF02125805