Current results with pediatric heart transplantation

Background. Cardiac transplantation is an accepted treatment for children w ith end-stage heart failure or complex or inoperable congenital defects. Methods. Since 1988, 95 transplants have been performed in 89 children aged 4 days to 18 years (median 6.9 years, 42 patients 0-5 years). Fifty-eight (61%) had congenital or acquired heart disease, 31 (33%) had idiopathic car diomyopathy, and 6 (6%) were retransplants. Fifty-seven of the patients had prior cardiac surgery with a range of one to eight procedures (mean 3.4 pr ocedures/patient). At the time of transplantation, 53 (56%) were United Net work for Organ Sharing (UNOS) status I, including 23 children on mechanical ventilation and 4 with mechanical circulatory support. Results. Thirty-day survival in this group was 96%. Posttransplant results showed a median time of ventilation of 1 day (mean 3.0 +/- 5.7 days), media n duration of inotropic support of 2 days (mean 2.7 +/- 2.3 days), median i ntensive care unit (ICU) stay of 4 days (mean 6.9 +/- 9.6 days), and median hospitalization of 9 days (mean 14.3 +/- 13.9 days). Follow-up from 1 mont h to 10.3 years (mean 3.1 years) has demonstrated a 1-year actuarial surviv al of 79% and a 5-year actuarial survival of 69%. Rejection, both acute and chronic, accounted for the vast majority of deaths. Conclusions. Pediatric heart transplantation can be accomplished with excel lent early survival despite multiple prior cardiac operations and relative severity of illness. Parameters such as postoperative ventilation, inotropi c support, ICU stay, and hospitalization can be kept at reasonable levels w ith acceptable long-term results, although rejection remains a serious prob lem. (C) 1999 by the Society of Thoracic surgeons.