Heart transplantation during the first 12 years of life. Loma Linda University Pediatric Heart Transplant Group
L. L. Bailey, M. Wood, A. Razzouk, G. Van Arsdell and S. Gundry
Department of Surgery, Loma Linda University Medical Center.
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.
