HEART-TRANSPLANTATION IN INFANTS - EXPERI ENCE AT THE CHILDRENS-HEART-CENTER IN GIESSEN

From June 1988 to December 1996 heart transplantations were performed in 36 newborns and infants below one year of age. Diagnosis were hypop lastic left heart syndrome (n = 26), endocardial fibroelastosis (n = 4 ), cardiomyopathy (n = 3), and other complex congenital heart defects (n = 3). Mean waiting time for transplantation was 52 days, the mean d onor-recipient bodyweight ratio was 1.8. Seven patients (19 %) died af ter transplantation mainly within the first month after transplantatio n. The cumulative probability of survival is 79 % in all patients. The influence of increasing experience is indicated when patients transpl anted from 1988-1993 (n = 15) are compared with transplants from 1994- 1996 (n = 21). The overall survival in the first group was 50 %, where as patients transplanted from 1994 showed a probability of survival of 92 %. The 1-year survival rate in the later group was 100 %. In 20 pa tients a total of 31 rejection episodes were observed; 2 infants died due to rejection. 71 % of all rejections occurred during the first mon th after transplantation. Renal function was slightly impaired one yea r after transplantation in all patients without tendency for deteriora tion in the sequel. The somatic development is normal in nearly all in fants and the quality of life is excellent. All infants live at home w ithout any restrictions. Two patients, however, suffer from a neurolog ic deficit. Until now there is no evidence of coronary vascular diseas e or malignancy. Heart transplantation is in our opinion a reconsidera ble alternative in the treatment of complex cardiac disease and cardio myopathy in infants.