RESUMO
OBJECTIVE: Short-term survival after pediatric heart transplantation is now excellent, but ultimately the efficacy of this procedure will depend on duration and quality of survival. We sought to evaluate the clinical course of long-term survivors of heart transplantation in childhood. METHODS: Patients who had undergone heart transplantation at the university hospitals of Stanford, Columbia, and Pittsburgh between 1975 and 1989 and survived longer than 5 years from transplantation were identified and their clinical courses retrospectively reviewed. RESULTS: Sixty eight children have survived more than 5 years from transplantation, and 60 (88%) are currently alive with a median follow-up of 6.8 years (5 to 17.9 years). Thirteen have survived more than 10 years from transplantation. Renal dysfunction caused by immunosuppressive agents was common, and two patients required late renal transplantation. Lymphoproliferative disease or other neoplasm occurred in 12 patients, but none resulted in death. Coronary artery disease was diagnosed in 13 patients (19%), leading to retransplantation in eight. Death after 5 years was related to acute or chronic rejection in 5 of 8 cases. Two of the deaths were directly related to noncompliance with immunosuppressive medication. All survivors are in New York Heart Association class 1. CONCLUSIONS: Long-term survival with good quality of life can be achieved after heart transplantation in childhood, though complications of immunosuppression remain common. Posttransplantation coronary artery disease is emerging as the main factor limiting long term graft and patient survival.
Assuntos
Transplante de Coração , Sobreviventes , Adolescente , Criança , Pré-Escolar , Doença das Coronárias/diagnóstico , Rejeição de Enxerto/tratamento farmacológico , Hemodinâmica , Humanos , Hipertensão/etiologia , Terapia de Imunossupressão/efeitos adversos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Lactente , Nefropatias/etiologia , Nefropatias/fisiopatologia , Transtornos Linfoproliferativos/diagnóstico , Transtornos Linfoproliferativos/etiologia , Pressão Propulsora Pulmonar , Qualidade de Vida , ReimplanteRESUMO
Between June 1984 and October 1986, we evaluated 22 children for possible cardiac transplantation at Columbia-Presbyterian Medical Center. Four children died awaiting donor organs. Fifteen children received transplants; eight had cardiomyopathy, and seven had congenital heart disease. One child received a heterotopic transplant because of extremely high pulmonary vascular resistance. Immunosuppressive therapy consisted of 4 to 40 mg/kg/d cyclosporine and 0.2 to 0.5 mg/kg/d prednisone. Rejection was detected by the presence of myocyte necrosis in surveillance endomyocardial biopsy specimens. There were one intraoperative and three early deaths, two from infection and one rejection. The 11 survivors are observed from a few weeks to more than 2 years after transplantation, and all are in excellent clinical health and participate in age-appropriate activities. These data corroborate the experience of other institutions that cardiac transplantation is a valid treatment in children.