Document Detail

Cardiac transplantation in pediatric patients: fifteen-year experience of a single center.
MedLine Citation:
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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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  79     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2005 Jan 
Date Detail:
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    
Other Details:
Languages:  eng     Pagination:  53-60; discussion 61     Citation Subset:  AIM; IM    
Department of Cardiac Surgery, Ludwig Maximilians University Hospital Munich-Grosshadern, Munich, Germany.
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MeSH Terms
Antiviral Agents / therapeutic use
Bacterial Infections / epidemiology
Cardiomyopathy, Dilated / surgery*
Child, Preschool
Cyclosporine / therapeutic use
Cytomegalovirus Infections / prevention & control
Extracorporeal Membrane Oxygenation
Follow-Up Studies
Ganciclovir / therapeutic use
Graft Rejection / mortality,  prevention & control
Heart Defects, Congenital / surgery*
Heart Failure / etiology,  surgery
Heart Transplantation / mortality,  statistics & numerical data*
Heart-Assist Devices
Immunosuppressive Agents / adverse effects,  therapeutic use
Life Tables
Lymphoma, Non-Hodgkin / epidemiology,  etiology
Mycophenolic Acid / analogs & derivatives*,  therapeutic use
Pneumonia, Pneumocystis / prevention & control
Postoperative Complications / epidemiology
Retrospective Studies
Survival Analysis
Survival Rate
Tacrolimus / therapeutic use
Treatment Outcome
Trimethoprim-Sulfamethoxazole Combination / therapeutic use
Vascular Resistance
Virus Diseases / epidemiology
Reg. No./Substance:
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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