Thorac Cardiovasc Surg 2014; 62 - v21
DOI: 10.1055/s-0034-1393997

Long term results after pediatric heart transplantation - improved treatment strategies increase survival

S. Schubert 1, O. Miera 1, R. Hetzer 2, C. Knosalla 2, D. Kemper 2, J. Photiadis 3, F. Berger 1
  • 1Department of Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin;
  • 2Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin
  • 3Department of Surgery of Congenital Heart defects, Deutsches Herzzentrum Berlin

Objective: Early and late mortality have significantly improved during recent decades in pediatric patients after heart transplantation (HTx). Survival is influenced by acute rejection, cardiac allograft vasculopathy, malignancy, renal failure or graft failure.

Methods: This study retrospectively evaluates the results after heart transplantation (HTx) in children (< 18 years): perioperative characteristics, probability of survival.

Results: 186 patients, transplanted between 05/1986 -12/2013, were included. Median age was 8.6 (0.02 - 18) years with diagnose: cardiomyopathy (CMP) (n=143), congenital heart disease (n=33) or other (n=10). Median survival was 8.8 (0.35-26.4) years. Overall survival at 1, 5, 10 and 20 years was 88%, 80%, 70% and 57%. Improved survival could be seen in patients receiving HTx in years 2000-2013 vs. 1986-1999. Risk factors for mortality were: low age and CHD. VAD prior HTx showed a slightly increased early mortality without influencing late mortality. 11 patients underwent re-transplantation due to graft failure: median post-transplant time of 12.45 (0.3-18.7) years. Late mortality was influenced by: rejection, PTLD (11.8%) and CAV with an incidence of 25% at 5 years, 50% at 10 years and approximately 75% at 15 years.

Conclusions: Pediatric HTx is an effective treatment of terminal heart failure. Previous VAD is not influencing long term mortality. Improved survival of the “new decade” (2000-2013) can be documented, achieved by adaptive immunosuppression and conclusive surveillance. Over 25y of survival can already be achieved.