European Journal of Cardio-Thoracic Surgery, Vol 3, 191-195, Copyright © 1989 by European Association for Cardio-thoracic Surgery
Heart- and heart-lung transplantation in children
PR Vouhe, J Le Bidois, P Dartevelle, G Touati, P Pouard, P Mauriat, P Jayais, D Sidi, J Kachaner and JY Neveux
Service de Chirurgie Cardiaque, Laennec Hospital, Paris, France.
Since January 1987, 16 prepubertal children have undergone heart (13) or
heart-lung (3) transplantation. Immunosuppression included cyclosporine and
azathioprine and excluded steroids except in case of rejection. The
indications for heart transplantation were hypoplastic left heart syndrome
(4 infants, mean age = 2 months), congenital heart disease (4 patients,
mean age = 5.7 years) and cardiomyopathy (5 patients, mean age = 2.8
years). There were 4 early deaths (acute graft failure in 2, pulmonary
hypertension in 1, infection in 1) and 1 late death (heart failure at 3
months). The 8 survivors had a mean follow-up of 12 months (range 1-19
months). Late complications were minimal. There were 4 episodes of
rejection in 2 patients. There was no infection, normal somatic growth and
no systemic hypertension. Renal function remained within normal limits
although mild-to-moderate tubulointerstitial lesions were found in 4 renal
biopsies. Three children (9-11 years old) underwent heart-lung
transplantation. The early postoperative course was difficult with 6
episodes of rejection and 5 infections. One patient died at 3 months from
infectious complications. One child has a complete rehabilitation 8 months
posttransplantation. The last patient is clinically well at 7 months but
has a residual tracheal stenosis. The long-term fate of these children, and
particularly the long-term effects of cyclosporine therapy are unknown.
Heart and heart-lung transplantation remain under investigation but may be
reasonable approaches for infants and children with end-stage cardiac
and/or pulmonary disease.
