Heart transplantation in children: clinical outcomes in a single center.

BACKGROUND

Despite being accepted as the best treatment for end-stage heart diseases, the long-term benefit of heart transplantation in children remains a matter of controversial debate. This study aimed to evaluate our clinical experience with heart transplantation in children.

METHODS

From March 1989 to December 1999, 93 consecutive orthotopic heart transplantations in children (less than 18 years of age) were performed at the Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW in Bad Oeynhausen, Germany. Clinical data were retrieved from a computerized database. Follow-up information was 100% completed.

RESULTS

The main indications for heart transplantation were dilated cardiomyopathy (68%) and congenital heart disease (31%). Early mortality risk was 14% +/- 3.6%. Primary graft failure (39%) was the main cause of early death. Total follow-up time was 694 patient-years (mean, 104.1 +/- 42.8 months). Twenty-three patients died during follow-up, resulting in 33 of 1,000 patient-years of late mortality rate. Acute rejection (43%) and allograft vasculopathy (26%) were attributed to late mortality. The 1-, 5-, 10-, and 15-year survival was 83%, 74%, 63%, and 50%, respectively. Recipient age less than one year (p = 0.02) and ischemia time greater than 300 minutes (p = 0.04) were associated with decreased survival. Social activities at the end of follow-up were school (69%), working (19%), and at home (12%).

CONCLUSIONS

Heart transplantation is a rational and durable treatment option for children with end-stage heart diseases. The long-term outcomes and quality of life after heart transplantation in children are encouraging.