OUTCOME AFTER REFERRAL FOR PEDIATRIC TRANSPLANTATION

Although heart, heart-lung, or lung transplantation is performed in mo re than 200 children annually, the number of patients referred for suc h procedures is considerably greater, and little is known about the ou tcome of those referrals. To determine the outcome of pediatric transp lant referrals we reviewed the follow-up of 31 patients evaluated at o ur institution for heart (24), heart-lung (three), or lung (four) tran splantations between January 1991 and September 1992. Indications incl uded hypoplastic left heart syndrome (seven patients), cardiomyopathy or myocarditis (seven patients), and postoperative congenital heart di sease (10 patients) for heart transplantation; Eisenmenger's syndrome (three patients) for heart-lung transplantation; and primary pulmonary hypertension (two patients), broncho pulmonary dysplasia, and cystic fibrosis for lung transplantation. Only 14 of 31 referred patients wer e listed for transplantation; the remaining 17 patients either improve d when medical therapy was maximized (nine patients), died within days of referral (three patients), refused (two patients), chose alternate surgery (one patient), were medically unacceptable (one patient), or are currently undecided (one patient). To date 7 of 14 patients listed have undergone successful heart transplantation; the remaining seven patients either improved and did not require transplantation (two pati ents), refused (one patient), died waiting (one patient), are currentl y awaiting a donor (one patient), or underwent Norwood procedure becau se of donor unavailability (two patients). Thus including patients who died before listing, only 14 of 31 referrals (45%) were deemed in nee d of a transplant. We conclude that referrals for transplantation shou ld be evaluated critically and triaged appropriately because medical m anagement may prevent or delay transplantation in 35% and that early e valuation may increase the chances of survival for those who require t ransplantation.