Favorable outcomes after heart transplantation in children: 18 years' experience of the national Dutch program at Erasmus MC.

H.P. Roest, M.H. van der Meulen, U.S. Kraemer, M. van Osch-Gevers, P.C. van de Woestijne, A.J.J.C. Bogers, M. Dalinghaus

Thursday 15 march 2018

12:20 - 12:30h at Van Rijck/Ruys Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 5: Clinical

Aim

To evaluate the outcome of our national program for pediatric heart transplantation (HTx).

Methods

In this retrospective, single-center, descriptive study we report the outcomes of all children listed for HTx at our center between 1999 and 2017.

Results

In total, 67 patients with end-stage heart disease were listed for HTx, 29 boys and 38 girls. The majority of the patients were diagnosed with a form of cardiomyopathy (CM) (43 dilated CM, 8 non-compaction CM, 6 restrictive CM, 3 hypertrophic CM, 2 after chemotherapy) and congenital heart disease in 5 patients. Forty-six (69%) children were transplanted at a mean age of 10.5 years, of whom 11 were on mechanical circulatory support (MCS). Forty-three children survived with a mean follow-up of 6.7 years, 3 died after a mean of 3.9 years. Twenty-one (31%) children were not transplanted: 17 died on the waiting list 8 of whom on MCS, 1 was delisted after improvement of cardiac function on MCS, and 3 were still listed.

Outcomes after HTx were overall favorable: all returning to school, leading relatively normal lives and participating in age-appropriate physical activities. In the majority of the recipients, graft function has been good at long-term follow-up. One child has residual neurological sequelae after a stroke on MCS. Post-transplantation complications include increased EBV loads, or (early) PTLD resulting in lowering of immunosuppression (n=2), treatment with Rituximab (n=5) or chemotherapy (n=1). We did not encounter major graft vascular disease. Compliance to the immunosuppressive treatment however has been a serious problem, leading to severe rejection and graft dysfunction in some young adolescents.

Conclusion

HTx in children has a low overall morbidity and mortality rate. Currently, donor availability and mortality on the waiting list is the major limiting factor for a successful HTx.