Neonatal cardiac transplantation. Intermediate-term results and incidence of rejection. Loma Linda University Pediatric Heart Transplant Group
M. Chiavarelli, M. M. Boucek, S. L. Nehlsen-Cannarella, S. R. Gundry, A. J. Razzouk and L. L. Bailey
Department of Surgery, Loma Linda International Heart Institute, CA.
Early age at cardiac transplantation may favor successful engrafting with
minimal chronic immunosuppression. Fifty-two newborns underwent orthotopic
heart transplantation; 47 (90%) survived the operation, and 44 (85%) were
late survivors. Actuarial survival was 92% at 1 month, 86% at 1 year, and
84% at 5 years. Forty-four infants who survived 12 weeks and the
corresponding 100 rejection episodes were analyzed. Mean follow-up was 2.2
years. The mean number of rejections per year of follow-up was 1.2. No
episodes of rejection were identified in six patients. Seven patients had a
late rejection episode more than 1 year after transplantation, and only one
had a late rejection episode after 2 years. Neonatal cardiac
transplantation is effective and durable therapy for uncorrectable heart
disease. Intermediate-term results are excellent. Severe rejection is
uncommon, and few episodes occur after 1 year of follow-up.
