|Cardiac transplantation in pediatric patients: fifteen-year experience of a single center.|
|PMID: 15620914 Owner: NLM Status: MEDLINE|
|BACKGROUND: Pediatric heart transplantation is a surgical therapy for dilated cardiomyopathy and for complex congenital heart defects with low pulmonary artery resistance. However, it is still discussed as controversial because of uncertain long-term results. We report our experience with pediatric heart transplantation in a heterogeneous population.
METHODS: Since 1988, 50 heart transplants were performed in 47 patients (30 with dilated cardiomyopathy, 17 with congenital heart disease). Mean age was 9.4 +/- 6.9 years (range, 4 days to 17.9 years). Twenty-three patients had a total of 36 previous operations. Clinical outcome was evaluated retrospectively.
RESULTS: Perioperative mortality was 6% due to primary graft failure. Late mortality (12%) was caused by acute rejection (n = 2), pneumonia (n = 2), intracranial hemorrhage (n = 1), and suicide (n = 1). Mean follow-up was 5.24 +/- 3.6 years. Actuarial 1, 5, and 10 year survival was 86%, 86%, and 80% and improved significantly after 1995 (92% [1 year]; 92% [5 years]). There was no significant difference between patients with dilated or congenital heart disease (1 year: 86% vs 82%; 5 years: 83% vs 74%; 10 years 83% vs 74%; p = 0.62). Three patients with therapy resistant acute or chronic rejection and assisted circulation underwent retransplantation and are alive. Freedom from acute rejection after 5 years was 40% with primary cyclosporine immunosuppression regime and 56% with tacrolimus. Since the introduction of mycophenolate mofetil, freedom from acute rejection increased to 62%. All survivors are at home and in good cardiac condition.
CONCLUSIONS: Pediatric heart transplantation is the treatment of choice for end-stage dilated cardiomyopathy as for congenital heart disease with excellent clinical midterm results. It is a valid alternative to reconstructive surgery in borderline patients. However, further follow-up is necessary to evaluate the long-term side effects of immunosuppressants.
|Jan Groetzner; Bruno Reichart; Ulrich Roemer; Stefanie Reichel; Rainer Kozlik-Feldmann; Andreas Tiete; Joerg Sachweh; Heinrich Netz; Sabine Daebritz|
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|Type: Journal Article; Review|
|Title: The Annals of thoracic surgery Volume: 79 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2005 Jan|
|Created Date: 2004-12-28 Completed Date: 2005-08-12 Revised Date: 2013-05-29|
Medline Journal Info:
|Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands|
|Languages: eng Pagination: 53-60; discussion 61 Citation Subset: AIM; IM|
|Department of Cardiac Surgery, Ludwig Maximilians University Hospital Munich-Grosshadern, Munich, Germany. firstname.lastname@example.org|
|APA/MLA Format Download EndNote Download BibTex|
Antiviral Agents / therapeutic use
Bacterial Infections / epidemiology
Cardiomyopathy, Dilated / surgery*
Cyclosporine / therapeutic use
Cytomegalovirus Infections / prevention & control
Extracorporeal Membrane Oxygenation
Ganciclovir / therapeutic use
Graft Rejection / mortality, prevention & control
Heart Defects, Congenital / surgery*
Heart Failure / etiology, surgery
Heart Transplantation / mortality, statistics & numerical data*
Immunosuppressive Agents / adverse effects, therapeutic use
Lymphoma, Non-Hodgkin / epidemiology, etiology
Mycophenolic Acid / analogs & derivatives*, therapeutic use
Pneumonia, Pneumocystis / prevention & control
Postoperative Complications / epidemiology
Tacrolimus / therapeutic use
Trimethoprim-Sulfamethoxazole Combination / therapeutic use
Virus Diseases / epidemiology
|0/Antiviral Agents; 0/Immunosuppressive Agents; 109581-93-3/Tacrolimus; 24280-93-1/Mycophenolic Acid; 59865-13-3/Cyclosporine; 8064-90-2/Trimethoprim-Sulfamethoxazole Combination; 82410-32-0/Ganciclovir; 9242ECW6R0/mycophenolate mofetil|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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