Heart Transplantation in Pediatric and Congenital Heart Disease

Purpose: To describe the indications and outcomes for pediatric patients and patients with congenital heart disease (CHD) undergoing heart transplantation (HT) in New Zealand. Methods: A retrospective audit of 253 patients who underwent HT from 1987 to end 2012 was undertaken. Thirty-seven patients were subdivided into two groups, those aged <18 years—pediatric heart disease (PHD) and those with CHD. Six patients aged <18 years were included in both the analyses. Demographic and clinical information were collected and outcomes established. Results: Overall actuarial survival of 37 patients with PHD or CHD was 92% at one year, 85% at five years, and 52% at ten years. The PHD group comprised 22 (8.7%) patients, median age 14 years (range 6-17), 14 (64%) male, with cardiomyopathy in 13, CHD in 6, and rheumatic heart disease in 3. At follow-up, 11 patients had died. Actuarial survival was 91% at one year and 79% at five years. Of the four patients with a mechanical assist device to bridge, three were transplanted and alive at follow-up. The CHD group comprised 21 (8.3%) patients, median age 25 years (range 6-48) and 19 (90%) were male. At follow-up, three patients had died. Actuarial survival was 95% at one year, 94% at five years, and 85% at ten years. All five patients with pre-HT Fontan circulation were alive a median of eight years following HT. Conclusion: Heart transplantation for carefully selected pediatric patients and patients with CHD can be successfully performed with favorable outcomes in a geographically isolated unit.

[1]  Margaret A. Tresler,et al.  Ten yr of pediatric heart transplantation: A report from the Pediatric Heart Transplant Study , 2013, Pediatric transplantation.

[2]  A. Israni,et al.  OPTN/SRTR 2011 Annual Data Report: Heart , 2013, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[3]  C. Canter,et al.  Trends in the indications and survival in pediatric heart transplants: a 24-year single-center experience in 307 patients. , 2012, The Annals of thoracic surgery.

[4]  A. Rahmel,et al.  The Registry of the International Society for Heart and Lung Transplantation: Fourteenth Pediatric Heart Transplantation Report--2011. , 2011, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[5]  R. Ohye,et al.  A United Network for Organ Sharing analysis of heart transplantation in adults with congenital heart disease: outcomes and factors associated with mortality and retransplantation. , 2010, The Journal of thoracic and cardiovascular surgery.

[6]  M. Kaufman,et al.  The adolescent transplant recipient. , 2010, Pediatric clinics of North America.

[7]  S. Russell,et al.  Heart transplantation for adults with congenital heart disease: analysis of the United network for organ sharing database. , 2009, The Annals of thoracic surgery.

[8]  Kirk R. Kanter,et al.  The effect of age, diagnosis, and previous surgery in children and adults undergoing heart transplantation for congenital heart disease. , 2009, Journal of the American College of Cardiology.

[9]  P. Macdonald Heart transplantation: who should be considered and when? , 2008, Internal medicine journal.

[10]  D. Bernstein,et al.  Pediatric cardiac transplantation. , 2006, Seminars in pediatric surgery.

[11]  D. Bernstein,et al.  Outcome of Listing for Cardiac Transplantation for Failed Fontan: A Multi-Institutional Study , 2006, Circulation.

[12]  C. Herrington,et al.  Pediatric cardiac transplantation. , 2004, Seminars in thoracic and cardiovascular surgery.

[13]  B. Griffith,et al.  Long-term survivors of pediatric heart transplantation: a multicenter report of sixty-eight children who have survived longer than five years. , 1997, The Journal of pediatrics.

[14]  B. Griffith,et al.  Pediatric cardiac transplantation. , 1990, Cardiovascular clinics.