Long-term outcome after infant versus pediatric heart transplantation

Introduction: Pediatric heart transplantation (HTX) is the last option for children with end-stage heart disease. Particularly newborn and infant HTX (< 1 year) needs a careful consideration due to the critical ill patient, organ availability and life-long immunosuppression. Therefore we focused on the outcome of these patients (pts), with the special interest in rejection, renal function, malignancies, coronary artery disease (CAV) and reHTX.

Methods: We reviewed the data of pts transplanted in our center <18 years (yrs) old between 1988-2010.

Results: 149 pts were transplanted, 82 (55%) as a newborn or infant (group A). 67 pts were older than 1 year (group B). The 10 year probability of survival for all pts is 80%, for group B 86% and infants 75%. Rejections occurred in 75% in the first year after HTX. 42 of all pts (31%) stayed rejection free, 16 in group A (19.5%) and 26 pts in group B (38.8%). 10 pts died due to a rejection, 7 in group A and 3 in group B. Renal function was reduced in group A with a GFR of 49ml/min/1.73m² (13.5-89.4). It improved to 72.1ml/min/1.73m² (46.7-128.3) at 9-10 yrs after HTX. Group B showed a normal or elevated renal function with 94.2ml/min/1.73m² (47.6-214.7) at HTX and 102ml/min/1.73m² (52.5-140) at 9-10 yrs. 2 pts received a kidney transplant. 11.4% of pts suffered from a malignancy. The majority of them were from group A. Median time after HTX at diagnosis was 6.7 yrs (0.7-14.9). 5 pts died at a median time of 7.8 yrs (5.4-14.1) after HTX. 9 pts of our survivors have a severe CAV. 3 pts were retransplanted due to CAV in the median of 10.5 yrs after HTX, 3 pts due to graft failure.

Conclusions: Newborn and infants tend to have more acute rejections and malignancies. Their preexisting renal dysfunction improves after HTX. Severe coronary artery disease and reHTX are not major morbidities yet, but will probably develop over time.