LONG-TERM RESULTS OF TRIPLE-DRUG-BASED IMMUNOSUPPRESSION IN NONNEONATAL PEDIATRIC HEART-TRANSPLANT RECIPIENTS

Background. Few reports document long-term results of pediatric cardia c transplantation in which triple therapy (cyclosporine, azathioprine, and corticosteroids) was the mainstay of immunosuppression. This repo rt details a single center's pediatric transplant experience and analy zes the relative contributions of selected pre/posttransplant risk fac tors on long-term morbidity and mortality. Methods. Retrospective data were collected for all non-neonatal pediatric transplant recipients i ncluding: presenting diagnosis, cardiac hemodynamics (particularly pul monary vascular resistance index), donor ischemic time, occurrence of postoperative infections, episodes of allograft rejection, incidence o f posttransplant lymphoproliferative disease or coronary artery diseas e (CAD), and overall survival. Analysis of single variables and a Cox- proportional hazards model were utilized to determine the impact of pr e/posttransplant risk factors on long-term survival. Results. From 198 4 to 1995, 64 patients (mean age, 8.3 years), 46 of whom had cardiomyo pathy and 18 who had inoperable complex congenital heart disease, unde rwent cardiac transplantation and received triple-drug immunosuppressi on. Orthotopic transplantation was performed unless the pulmonary vasc ular resistance index remained >6 um(2) (despite use of pulmonary vaso dilator). One patient required heterotopic transplantation. Average do nor ischemic time was 217 min. An average of 1.2 rejection episodes/pa tient occurred (average follow-up period: 50 months). No patient devel oped posttransplant lymphoproliferative disease, but 22 patients (34%) developed CAD. Overall survival was 80%, 60%, and 57% at 1, 5, and 10 years, respectively. Of outcome variables analyzed, rejection frequen cy was significantly increased in patients who subsequently developed CAD, but the presence of CAD was not significantly correlated with mor tality. Conclusion. Triple-drug-based immunosuppressive maintenance th erapy in pediatric heart transplant recipients results in good long-te rm graft survival.