PEDIATRIC CARDIAC TRANSPLANTATION - EVOLU TION AND EARLY POSTOPERATIVE COMPLICATIONS

BACKGROUND: Cardiac transplantation is an acceptable therapeutic alter native for cardiac diseases refractory to other forms of management in adults as well as in infants and children. METHODS: Between 1987-1992 7 children (4 girls and 3 boys) underwent cardiac transplantation: fo ur with dilated cardiomyopathy, one with cardiac fibroma and two with hypertrophic cardiomyopathy. Age at transplantation ranged from 2 mont hs to 13 years and 5 months, with a follow up ranging from 15 months t o 5 years and 9 months. Prophylaxis of acute rejection consisted of cy closporine, azathioprine and glucocorticoids. RESULTS: TWO patients pr esented acute rejection three weeks after cardiac transplantation, wit h a good response to high dose glucocorticoids. Two patients developed severe infection (sepsis by Staphylococcus aureus) with successful ou tcome after antibiotic treatment. One patient died in the early postop erative period and other after 4 years II months postransplantation be cause myelodysplastic syndrome. At present only one case is receiving glucocorticoids in immunoprophylaxis. The status is asymptomatic in th e other 5 patients with a normal height-weight development. CONCLUSION S: Heart transplantation provides durable therapy for congenital and m yophatic heart disease in infants and children with an excellent quali ty of life.