Ferrazzi P, Fiocchi R, Gamba A, Mamprin F, Senni M, Glauber M, Troise G, Parenzan L
Department of Cardiac Surgery, Ospedali Riuniti di Bergamo, Italy.
J Heart Lung Transplant. 1993 Nov-Dec;12(6 Pt 2):S241-5.
From 1986 to February 1993, 40 children aged 2 months to 18 years (average age 10.4 +/- 5.8 years) underwent heart transplantation. Indications for transplantation were idiopathic cardiomyopathy (52%), congenital heart disease (35%) with and without prior repair (71% and 29%, respectively), hypertrophic cardiomyopathy (5%), valvular heart disease (3%), and doxorubicin cardiomyopathy (5%). Patients were managed with cyclosporine and azathioprine. No prophylaxis with antilymphocyte globulin was used. Steroids were given to 39% of patients for refractory rejection, but weaning was always attempted and generally successful (64%). Five patients (14%) received maintenance steroids. Four patients died in the perioperative period and one died 4 months later. There have been no deaths related to rejection or infection. Average follow-up was 36 +/- 19 months (range 1 to 65 months). Cumulative survival is 88% at 5 years. In patients less than 7 years of age, rejection was monitored noninvasively. In the first postoperative month, 89% of patients were treated for rejection. Freedom from serious infections was 83% at 1 month and 65% at 1 year. Cytomegalovirus infections were treated successfully with ganciclovir in 11 patients. No impairment of growth was observed in children who underwent transplantation compared with a control population. Twenty-one patients (60%) have undergone annual catheterizations and no sign of graft atherosclerosis has been observed. Seizures occurred in five patients (14%) and hypertension was treated in 10 patients (28%). No patient was disabled and no lymphoproliferative disorder was observed.(ABSTRACT TRUNCATED AT 250 WORDS)
1986年至1993年2月，40名年龄在2个月至18岁（平均年龄10.4±5.8岁）的儿童接受了心脏移植。移植指征包括特发性心肌病（52%）、先天性心脏病（35%），其中有和没有既往手术史的分别占71%和29%、肥厚型心肌病（5%）、心脏瓣膜病（3%）以及阿霉素性心肌病（5%）。患者接受环孢素和硫唑嘌呤治疗。未使用抗淋巴细胞球蛋白进行预防。39%的患者因难治性排斥反应接受类固醇治疗，但总是尝试撤药且通常成功（64%）。5名患者（14%）接受维持性类固醇治疗。4名患者在围手术期死亡，1名在4个月后死亡。没有与排斥反应或感染相关的死亡。平均随访时间为36±19个月（范围1至65个月）。5年累积生存率为88%。7岁以下患者通过非侵入性方法监测排斥反应。术后第一个月，89%的患者接受了排斥反应治疗。术后1个月无严重感染的比例为83%，1年时为65%。11名患者的巨细胞病毒感染用更昔洛韦成功治疗。与对照组相比，接受移植的儿童未观察到生长发育受损。21名患者（60%）每年接受导管检查，未观察到移植物动脉粥样硬化迹象。5名患者（14%）发生癫痫，10名患者（28%）接受高血压治疗。没有患者致残，也未观察到淋巴增生性疾病。（摘要截短于250字）
