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Eur J Cardiothorac Surg 2007;32:220-224. doi:10.1016/j.ejcts.2007.03.049
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Outcome after pediatric heart transplantation: two decades of a single center experience

^a Department of Cardiovascular Surgery, University of Padova, Padova, Italy
^b Department of Pediatrics, University of Padova, Padova, Italy
^c Department of Cardiology, University of Padova, Padova, Italy
^d Department of Pathology, University of Padova, Padova, Italy

Received 26 June 2006; received in revised form 5 March 2007; accepted 6 March 2007.

^_* Corresponding author. Address: Istituto di Cardiochirurgia, Azienda Ospedaliera – Università degli Studi di Padova, Dipartimento di Scienze Cardiologiche, Toraciche, Vascolari, Sezione di Cardiochirurgia, Via Giustiniani, 2, 35128 Padova, Italy. Tel.: +39 0498212410; fax: +39 0498211895. (Email: gino.gerosa{at}unipd.it).

Background: Twenty years after the first successful pediatric heart transplantation (HTx), the long-term outcome of this population is still unknown. Current study analyzes our results in pediatric HTx population. Methods and results: Between 1985 and 2005, we performed 604 HTx. Forty-three patients (7%) were less than 18-years old and six patients were less than 1-year old. Mean age at HTx was 9.7 ± 6.3 years (38 days–18 years). Indications were: cardiomyopathy in 33 patients (76%), congenital in 9 (21%), tumor in 1 (3%). Chronic immunosuppression was Cyclosporine A and Azathioprine-based. Overall survival at Kaplan–Meier analysis (CI 95%) was 82.5% at 1-year post-HTx, 73.5% at 5 years, 72.2% at 10 years, 62.1% at 15 years, and 49.3% at 20 years, respectively. We had 14 deaths (32%): 7 within the first year after HTx (early mortality, EM), 7 occurred later (late mortality, LM). Causes of EM were: graft failure (43%), acute rejection (43%) and post transplant lymphoproliferative disease (14%). Causes of LM were: neoplasms (57%), infection (28%), graft vasculopathy (15%). At late follow-up, cardiac function, somatic and psychoaffective development were normal. Fifteen patients (34%) developed neoplasms, nine patients (21%) hypertension, and three patients (8%) developed kidney dysfunction. Neoplasms were found to be an independent predictor of outcome (p = 0.039) (OR = 7). Conclusions: Overall survival in the pediatric population is better than adults’ population (62.1 vs 48% at 15 years after HTx). Neoplasms were the main comorbidities and causes of LM: at multivariate analysis, their incidence was related with hematic Cyclosporine A levels after 10 years from HTx (p = 0.01).

Key Words: Heart transplantation • Pediatric • Immunosuppressive therapy • Neoplasms • CAV • PTLD