Abstract • Since November 1985, forty-four heart transplants have been accomplished in 43 infants and children younger than 12 years of age. Indications for transplantation included structural heart disease (31 patients), idiopathic or viral cardiomyopathy (10 patients), and combined structural and myopathic disease (2 patients). Postoperative recipient surveillance was achieved noninvasively during the first year of life; endomyocardial biopsy was employed in children. Maintenance immunosuppression included cyclosporine and azathioprine therapy during the first year after transplantation in young infants, graduating to cyclosporine therapy alone beyond the first year. Azathioprine therapy was continued indefinitely in children. There have been 5 perioperative deaths and 1 late death in this series of recipients. Overall survival was 86%. Growth, development, and psychosocial adjustments generally have been excellent. Donor heart growth has been normal. Coronary artery disease has not yet been observed. Our findings indicate that heart transplantation seems to be effective therapy for selected incurable pediatric cardiac diseases. (Arch Surg. 1989;124:1221-1226) References 1. Barnard CN. Cardiac transplantation: an evaluation of the first two operations performed at Groote Schuur Hospital, Cape Town . Am J Cardiol . 1968;22:584.Crossref 2. Cooley DA, Bloodwell RD, Hallman GL, Nora JJ. Transplantation of the human heart . JAMA . 1968;205:479-486.Crossref 3. Penkoske PA, Rowe RD, Freedom RM, Trusler GA. The future of heart and heart-lung transplantation in children . Heart Transplant . 1984;3:233-238. 4. Pennington DG, Sarafian J, Swartz M. Heart transplantation in children . Heart Transplant . 1985;4:441-445. 5. Jamieson SW, Oyer P, Baldwin J, Billingham M, Stinson E, Shumway N. Heart transplantation for end-stage ischemic heart disease: the Stanford experience . Heart Transplant . 1984;3:224-227. 6. Fricker FJ, Griffith BP, Hardesty RL, et al. Experience with heart transplantation in children . Pediatrics . 1987;79:138-146. 7. Starnes VA, Stinson EB, Oyer PE, et al. Cardiac transplantation in children and adolescents . Circulation . 1987;76( (suppl 5) ):V43-V47. 8. Addonizio LJ, Rose EA. Cardiac transplantation in children and adolescents . J Pediatr . 1987;111:1034-1038.Crossref 9. Bailey LL, Nehlsen-Cannarella SL, Doroshow RW, et al. Cardiac allo-transplantation in newborns as therapy for hypoplastic left heart syndrome . N Engl J Med . 1986;315:949-951.Crossref 10. Bailey LL, Assaad AN, Trimm RF, et al. Orthotopic transplantation during early infancy as therapy for incurable congenital heart disease . Ann Surg . 1988;208:279-296.Crossref 11. Mavroudis C, Harrison H, Klein JB, et al. Infant orthotopic cardiac transplantation . J Thorac Cardiovasc Surg . 1988;96:912-924. 12. Bailey LL, Concepcion W, Shattuck H, Huang L. Method of heart transplantation for treatment of hypoplastic left heart syndrome . J Thorac Cardiovasc Surg . 1986;92:1-5. 13. Kanakriyeh MS, Mullins CE, Parisi F, Petry EL, Bailey LL. Late hemodynamic results after orthotopic heart transplantation in early infancy . Circulation . 1988;78:294.
Archives of Surgery – American Medical Association
Published: Oct 1, 1989