MEDIUM-TERM RESULTS OF NONINVASIVE FOLLOW -UP AFTER CARDIAC TRANSPLANTATION IN CHILDHOOD AND ADOLESCENCE

Between December 1984 and September 1996, 43 cardiac transplantations were carried out in 40 patients aged 2 days to 21 years (one third und er 10 years of age) for cardiomyopathy (21 cases), congenital heart di sease (19 cases) or retransplantation (3 cases). The average waiting t ime for transplantation was 80 days : this delay increased by a factor of five in 2 years (from 1 month, before 1994, to 5 months at present ). Twelve patients dies, including 6 before the 8th day. The 28 surviv ors were prescribed triple immunosuppressive therapy : the average fol low-up was 4.4 years (range 3 months to 11 years). Monitoring rejectio n was carried out by non-invasive methods based on clinical, electroca rdiographic and Doppler echocardiographic observations. Any suspicion of acute rejection led to endomyocardial biopsy for confirmation and t herapeutic guidance. There was a total of 47 episodes of acute rejecti on (0-3 per patient), mainly in the first 3 months; acute rejection wa s less common in the younger children. Graft function was normal in 71 % of cases. Five children have a pacemaker implanted during the first month. Despite continuous steroid therapy, 82% of patients had normal staturo-ponderal growth. The myocardial mass of the graft increased in parallel with the body surface aera. Nephrotoxicity of ciclosporine w as responsible for significant renal failure in 19% of patient and see med more common in the young children. Psychological disturbances were commonest in adolescence and could result in poor treatment complianc e (4 cases, with 1 death and 2 retransplantations). Despite satisfacto ry medium-term results, nephrotoxicity of ciclosporine, long-term graf t function and psychological difficulties of adolescents remain unreso lved so that transplantation is reserved for terminal cardiac disease resistant to all other forms of treatment.