[Pediatric heart transplantation 1990].

In this presentation the author updates the progress made in pediatric cardiac transplantation through a review of the results obtained at Ste-Justine Hospital (SJH) and of the recent literature. Of 56 children referred to SJH for cardiac transplantation, 27 met the selection criteria; 10 died before receiving a new heart and 2 are still awaiting transplantation. Fifteen children, aged 3 to 16 years, have received a transplant. Ten of them had 32 birth defects, all of which were repaired at the time of transplantation thanks to improved graft removal methods and innovative surgical techniques. This study demonstrates that birth defects are not a contraindication to cardiac transplantation in children. Triple-drug immunosuppression was used, and the cyclosporine blood levels were maintained in the range of 100 to 200 ng/mL. Survival at 2 years was 78%. Episodes of acute rejection occurred at a rate of 0.5 per patient, 85% of them within the first 3 months after transplantation. Adequate renal function was preserved (creatinine clearance between 89 and 102 mL/min.m-2). The use of low-dose cyclosporine might explain in part the lack of significant nephrotoxicity. Reversible high blood pressure was observed in 5 of 13 patients during the first 6 months postoperatively. Multifactorial analysis identified, as a likely cause, a higher dose of steroids and cyclosporine during this period. Annual coronary angiography did not reveal any lesion, and apart from the acute rejection episodes, cardiac function was normal at rest, and the transplanted children have maintained an excellent level of activity.(ABSTRACT TRUNCATED AT 250 WORDS)