Clinical outcome 10 years after infant heart transplantation

The feasibility of heart transplantation for infants has now been establish ed. Clinical outcome data is necessary to assist in targeting areas for imp rovement and for counseling families considering this option. This report d escribes clinical outcome in 29 infant heart transplant recipients who have survived at least 10 years. A query of the transplant database, referring physicians and parental questionnaire was performed. Patient survival for t he overall infant population is 64% at 13 years. Parents of 19/29 (55%) chi ldren described them as developmentally normal. Three children have had a s evere developmental outcome. Sixteen of 29 children are in mainstream schoo l environments. Four have repeated one grade in school. Speech delay was pr esent in 10/26 (38%). Somatic growth is normal in 88%. All children are NYH A class I. Renal function shows only modest insufficiency with most recent BUN (mean +/- S.D.) = 25 +/- 7 mg/dl and serum creatinine = 0.8 +/- 0.2 mg/ dl. Only four children have creatinine levels > 1 mg/dl. No child requires dialysis. No children have developed post-transplant lymphoproliferative di sease beyond 10 years. Four children have experienced rejection beyond 10 y ears with one mortality due to rejection and transplant coronary artery dis ease. Conclusion: Heart transplantation during infancy is technically feasi ble and results in good survival. Many children have some degree of learnin g disability but most are mild and the children function well in society. I mprovements in surgical techniques may improve developmental outcome. Other side-effects of immunosuppression are manageable and most survivors have a good functional outcome. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.