PEDIATRICS Vol. 79 No. 1 January 1987, pp. 138-146
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Experience With Heart Transplantation in Children

F. Jay Fricker MD1, Bartley P. Griffith MD1, Robert L. Hardesty MD1, Alfredo Trento MD1, Larry M. Gold ACSW1, Kathy Schmeltz RN1, Lee B. Beerman MD1, Donald R. Fischer MD1, Robert A. Mathews MD1, William H. Neches MD1, Sang C. Park MD1, J. R. Zuberbuhler MD1, C. C. Lenox MD1, and Henry T. Bahnson MD1

1 From the Departments of Cardiology and Cardiothoracic Surgery, Children's Hospital and the University of Pittsburgh, Pittsburgh

Between March 1981 and March 1986, 200 orthotopic heart transplantations were performed at the University of Pittsburgh. Fourteen of those procedures were carried out in children 2 to 16 years of age. Two children received combined liver and heart transplants; one because of familial hypercholesterolemia with associated ischemic heart disease, and the other because of dilated cardiomyopathy associated with intrahepatic biliary atresia. Eight patients had dilated cardiomyopathy, and two had myocarditis. Two had heart transplantations for congenital heart disease: one had multiple muscular ventricular septal defects repaired in infancy and had an associated cardiomyopathy, and the other developed a cardiomyopathic ventricle from a congenital right coronary artery to right atrial fistula. Chronic immune suppression consisted 0.2 to 0.5 mg/kg/d of prednisone and 5 to 50 mg/kg/d cyclosporine, with the addition of antithymocyte globulin for unresolved moderate or severe acute rejection. There were three early postoperative deaths: one from intracranial bleeding, one from Pseudomonas mediastinitis, and one from ischemic injury to transplanted organs. Early postoperative complications included reversible renal failure, hypertension, and seizures. Late problems were related to allograft rejection and side effects of cyclosporine and corticosteroids. Significant rejection episodes occurred in all patients surviving longer than 2 weeks, with seven requiring antithymocyte globulin. Two patients died 8 months following transplantation of severe acute and chronic rejection; another patient required retransplantation for ischemic cardiomyopathy resulting from chronic rejection but subsequently died of recurring rejection 3 months after the second transplantation. Eight surviving patients 4 months to 4 years after heart transplantation had returned to age-appropriate activities. These early results have encouraged the authors to continue to use heart transplantation as a viable alternative in children with terminal heart disease.

Key Words: heart transplantation

Submitted on March 3, 1986
Accepted on July 31, 1986




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