Intermediate and long-term results after pediatric heart transplantation

Incidence and role of pretransplant diagnosis

F. Parisi, A. Carotti, F. Esu, A. D. Abbattista, M. P. Cicini, C. Squitieri

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

From November 1985 to 31 July 1997, 65 pediatric patients underwent heart transplantation at Bambino Gesù Hospital in Rome. Two of them underwent retransplantation, both 6 years after the first transplant. The 67 transplant patients had a mean age of 59 months; 11 were under 1 year of age. Their indications for transplantation were cardiomyopathies (38), lymphocytic myocarditis (8), and congenital heart diseases (19). Two patients of the first group successfully received a combined heart and kidney transplant. The 1-, 5-, and 11-year actuarial survival rates for the 65 patients who underwent heart transplantation were 68%, 62%, and 42%, respectively. In the 1st postoperative year in patients who had had cardiomyopathy, a total of 50 episodes of acute rejection (AR), with one death, occurred (mean 1.7 AR/patient per year ± 1.5) and, in patients who had had congenital heart diseases, 19 ARs (one death) occurred with a mean of 1.58 AR/ patient per year ± 1.4. The incidence of AR was significantly higher in patients who had had myocarditis with a total of 26 episodes (mean 3.7 AR/patient per year ± 2) and one death. Rehabilitation of heart transplanted children and infants was complete (NYHA class 1) in 52% of patients of this series. We conclude that heart transplantation may give a good intermediate and long-term survival in selected patients; the extension of indications to desperately ill patients, or patients with systemic diseases or complex congenital heart diseases may bring less encouraging results, but should not be definitely excluded. Scarcity of donors remains the main limit, being still the first cause of death for patients on our waiting list. Our limited experience seems to suggest that, as described in adults, the cellular amplification of the immune response might affect the post-heart transplant follow up of pediatric patients with myocarditis resulting in a poor outcome for this population.

Original languageEnglish
JournalTransplant International
Volume11
Issue numberSUPPL. 1
Publication statusPublished - 1998

Fingerprint

Heart Transplantation
Pediatrics
Incidence
Myocarditis
Transplants
Heart Diseases
Cardiomyopathies
Waiting Lists
Cellular Immunity
Cause of Death

Keywords

  • Long-term follow up
  • Pediatric heart transplantation
  • Pediatric myocarditis

ASJC Scopus subject areas

  • Transplantation

Cite this

Intermediate and long-term results after pediatric heart transplantation : Incidence and role of pretransplant diagnosis. / Parisi, F.; Carotti, A.; Esu, F.; Abbattista, A. D.; Cicini, M. P.; Squitieri, C.

In: Transplant International, Vol. 11, No. SUPPL. 1, 1998.

Research output: Contribution to journalArticle

@article{0a3704ff38464507a4a4f5cc32ade603,
title = "Intermediate and long-term results after pediatric heart transplantation: Incidence and role of pretransplant diagnosis",
abstract = "From November 1985 to 31 July 1997, 65 pediatric patients underwent heart transplantation at Bambino Ges{\`u} Hospital in Rome. Two of them underwent retransplantation, both 6 years after the first transplant. The 67 transplant patients had a mean age of 59 months; 11 were under 1 year of age. Their indications for transplantation were cardiomyopathies (38), lymphocytic myocarditis (8), and congenital heart diseases (19). Two patients of the first group successfully received a combined heart and kidney transplant. The 1-, 5-, and 11-year actuarial survival rates for the 65 patients who underwent heart transplantation were 68{\%}, 62{\%}, and 42{\%}, respectively. In the 1st postoperative year in patients who had had cardiomyopathy, a total of 50 episodes of acute rejection (AR), with one death, occurred (mean 1.7 AR/patient per year ± 1.5) and, in patients who had had congenital heart diseases, 19 ARs (one death) occurred with a mean of 1.58 AR/ patient per year ± 1.4. The incidence of AR was significantly higher in patients who had had myocarditis with a total of 26 episodes (mean 3.7 AR/patient per year ± 2) and one death. Rehabilitation of heart transplanted children and infants was complete (NYHA class 1) in 52{\%} of patients of this series. We conclude that heart transplantation may give a good intermediate and long-term survival in selected patients; the extension of indications to desperately ill patients, or patients with systemic diseases or complex congenital heart diseases may bring less encouraging results, but should not be definitely excluded. Scarcity of donors remains the main limit, being still the first cause of death for patients on our waiting list. Our limited experience seems to suggest that, as described in adults, the cellular amplification of the immune response might affect the post-heart transplant follow up of pediatric patients with myocarditis resulting in a poor outcome for this population.",
keywords = "Long-term follow up, Pediatric heart transplantation, Pediatric myocarditis",
author = "F. Parisi and A. Carotti and F. Esu and Abbattista, {A. D.} and Cicini, {M. P.} and C. Squitieri",
year = "1998",
language = "English",
volume = "11",
journal = "Transplant International",
issn = "0934-0874",
publisher = "Blackwell Publishing Ltd",
number = "SUPPL. 1",

}

TY - JOUR

T1 - Intermediate and long-term results after pediatric heart transplantation

T2 - Incidence and role of pretransplant diagnosis

AU - Parisi, F.

AU - Carotti, A.

AU - Esu, F.

AU - Abbattista, A. D.

AU - Cicini, M. P.

AU - Squitieri, C.

PY - 1998

Y1 - 1998

N2 - From November 1985 to 31 July 1997, 65 pediatric patients underwent heart transplantation at Bambino Gesù Hospital in Rome. Two of them underwent retransplantation, both 6 years after the first transplant. The 67 transplant patients had a mean age of 59 months; 11 were under 1 year of age. Their indications for transplantation were cardiomyopathies (38), lymphocytic myocarditis (8), and congenital heart diseases (19). Two patients of the first group successfully received a combined heart and kidney transplant. The 1-, 5-, and 11-year actuarial survival rates for the 65 patients who underwent heart transplantation were 68%, 62%, and 42%, respectively. In the 1st postoperative year in patients who had had cardiomyopathy, a total of 50 episodes of acute rejection (AR), with one death, occurred (mean 1.7 AR/patient per year ± 1.5) and, in patients who had had congenital heart diseases, 19 ARs (one death) occurred with a mean of 1.58 AR/ patient per year ± 1.4. The incidence of AR was significantly higher in patients who had had myocarditis with a total of 26 episodes (mean 3.7 AR/patient per year ± 2) and one death. Rehabilitation of heart transplanted children and infants was complete (NYHA class 1) in 52% of patients of this series. We conclude that heart transplantation may give a good intermediate and long-term survival in selected patients; the extension of indications to desperately ill patients, or patients with systemic diseases or complex congenital heart diseases may bring less encouraging results, but should not be definitely excluded. Scarcity of donors remains the main limit, being still the first cause of death for patients on our waiting list. Our limited experience seems to suggest that, as described in adults, the cellular amplification of the immune response might affect the post-heart transplant follow up of pediatric patients with myocarditis resulting in a poor outcome for this population.

AB - From November 1985 to 31 July 1997, 65 pediatric patients underwent heart transplantation at Bambino Gesù Hospital in Rome. Two of them underwent retransplantation, both 6 years after the first transplant. The 67 transplant patients had a mean age of 59 months; 11 were under 1 year of age. Their indications for transplantation were cardiomyopathies (38), lymphocytic myocarditis (8), and congenital heart diseases (19). Two patients of the first group successfully received a combined heart and kidney transplant. The 1-, 5-, and 11-year actuarial survival rates for the 65 patients who underwent heart transplantation were 68%, 62%, and 42%, respectively. In the 1st postoperative year in patients who had had cardiomyopathy, a total of 50 episodes of acute rejection (AR), with one death, occurred (mean 1.7 AR/patient per year ± 1.5) and, in patients who had had congenital heart diseases, 19 ARs (one death) occurred with a mean of 1.58 AR/ patient per year ± 1.4. The incidence of AR was significantly higher in patients who had had myocarditis with a total of 26 episodes (mean 3.7 AR/patient per year ± 2) and one death. Rehabilitation of heart transplanted children and infants was complete (NYHA class 1) in 52% of patients of this series. We conclude that heart transplantation may give a good intermediate and long-term survival in selected patients; the extension of indications to desperately ill patients, or patients with systemic diseases or complex congenital heart diseases may bring less encouraging results, but should not be definitely excluded. Scarcity of donors remains the main limit, being still the first cause of death for patients on our waiting list. Our limited experience seems to suggest that, as described in adults, the cellular amplification of the immune response might affect the post-heart transplant follow up of pediatric patients with myocarditis resulting in a poor outcome for this population.

KW - Long-term follow up

KW - Pediatric heart transplantation

KW - Pediatric myocarditis

UR - http://www.scopus.com/inward/record.url?scp=0031609892&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031609892&partnerID=8YFLogxK

M3 - Article

VL - 11

JO - Transplant International

JF - Transplant International

SN - 0934-0874

IS - SUPPL. 1

ER -