Abstract
Heart transplantation (Tx) is gaining acceptance as a treatment for young patients with end stage cardiac disease, although the reported data are limited and follow-up brief. From 1/74 through 8/86, 30 patients with cardiomyopathy and 4 with congenital heart disease (ages 2.8-18.9 years; 24M/10F) received Tx at Stanford. Immunosuppression was accomplished with steroids, azathioprine, anti-thymocyte globulin and after 1980, with cyclosporine. Re-Tx was required for intractable rejection (3) and advanced coronary disease (1). Twenty three patients are alive 2 weeks-9.6 years post-Tx. Age at Tx did not affect survival. All are active (NYH Class I), and attend school or work. In the 11 fatalities, post-Tx survival ranged between 2 days and 11.4 years. Death was due to infection (5), rejection (3), graft failure (1), lymphoma (1) and coronary disease (1). Our 99.1 patient year experience yielded linearized infection and rejection rates of 1.1 and 0.6 episodes/patient year, respectively. Of 6 patients with recognized coronary disease, 3 demonstrated the disorder as soon as 2 years post-Tx. Hypertension requiring therapy invariably developed in patients given cyclosporine. Based upon data from Stanford's 34 patients, probability for post-Tx survival is 78% at 2 years and 66% at 5 years. These long term observations suggest that Tx deserves consideration for selected young patients with end stage cardiac disease.
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Baum, D., Stinson, E., Oyer, P. et al. DO LONG TERM RESULTS JUSTIFY PEDIATRIC HEART TRANSPLANTATION?. Pediatr Res 21 (Suppl 4), 186 (1987). https://doi.org/10.1203/00006450-198704010-00117
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DOI: https://doi.org/10.1203/00006450-198704010-00117