BLESS THE BABIES - 115 LATE SURVIVORS OF HEART-TRANSPLANTATION DURINGTHE 1ST YEAR OF LIFE

There is a rapid growth of interest in heart transplantation therapy d uring early infancy. From 10% to 25% of the infants who are listed for transplantation annually have died while awaiting a donor heart. Ther e has been no significant trend in this variable. Since November 1985, 140 consecutive orthotopic transplantation procedures were performed in 139 infants who were from 3 hours to 12 months of age. Indications for transplantation included hypoplastic left heart syndrome (63%), ot her complex structural anomalies (29%), myopathy (6.5%), and tumors (1 .5%). Most recipients had ductus-dependent circulation and received co ntinuous infusion of prostaglandin E1. Heart donors were usually victi ms of trauma, sudden infant death, or birth asphyxia. A donor-recipien t weight ratio of 4.0 or less was found to be acceptable. The amount o f time the graft underwent cold ischemia, ranged from 64 to 576 minute s. The procurement process was facilitated by a single dose of cold cr ystalloid cardioplegic solution and cold immersion transport. Profound hypothermic circulatory arrest was used for graft implantation. One h undred twenty-four (89%) recipients survived transplantation and were discharged from the hospital. There were 9 late deaths, which resulted in an 83% overall survival. The 5-year actuarial survival is 80%. The survival among newborn recipients (n = 60) at 5 years is 84%. Chronic immunomodulation was cyclosporine-based and steroid-free. Surveillanc e was noninvasive and relied heavily on echocardiography, electrocardi ography, and clinical intuition. There was one documented late lethal infection, tumor was not encountered, and coronary occlusive disease w as known to exist in only one long-term survivor. We concluded that tr ansplantation results in excellent life quality and is a highly effect ive and durable therapy when applied during early infancy.