28. Current Results with Pediatric Heart Transplantation
Kirk R. Kanter, Vincent K. H. Tam, Robert N. Vincent
Egleston Childrens Hospital at Emory University
Atlanta, Ga.
Cardiac transplantation is an accepted treatment for children with end-stage heart failure or complex or inoperable congenital defects. Since 1988, 88 transplants have been performed in 84 children aged six days to 18 years (median 6.7 years, 40 patients 0-5 years). Fifty-three (60 percent) had congenital or acquired heart disease; 31 (37 percent) had idiopathic cardiomyopathy. Fifty-one of the patients had prior cardiac surgery with a range of one to eight procedures (mean 3.2 procedures/patient). At the time of transplantation, 49 (56 percent) were UNOS status one including 22 children on mechanical ventilation and four with mechanical circulatory support.
Thirty day survival in this group was
95 percent. Post-transplant variables are shown below:
| Median | Mean (+ S.D.) | Range | |
| Ventilation (days) | 1 | 3.1 (+ 5.9) | 0-30 |
| Inotropic support (days) | 2 | 2.7 (+ 2.4) | 0-13 |
| ICU stay (days) | 4 | 7.0 (+ 9.9) | 1-56 |
| Hospitalization | 9 | 14.7 (+ 14.4) | 5-82 |
Follow up from one month to 9.8 years (mean 2.7 years) has demonstrated a one year actuarial survival of 81 percent and a five year actuarial survival of 72 percent.
In summary, pediatric heart transplantation can be accomplished with excellent early survival despite multiple prior cardiac operations and relative severity of illness. Parameters such as postoperative ventilation, inotropic support, ICU stay, and hospitalization can be kept at reasonable levels with acceptable long-term results.