INFEZIONI NEI TRAPIANTI DI CUORE E CUORE-POLMONE: ESPERIENZA PEDIATRICA

Between February 1986 and March 1993, 40 heart transplants in 39 children (19 M, 20 F), aged 17 days-14,8 years, were performed by Bambino Gesu Pediatric Hospital. The follow-up of 29 patients ranges from 2 to 87 months. Since February 1991, in particular, 5 patients (2 M, 3 F), aged 5-18 months, were heart-lung transplanted and followed from 5 to 11 months. During the follow-up, 22 episodes of serious infection were observed in 16 children with heart transplant (mean 1,3 infective episode/infected patient) and 11 serious infections in the 5 heart-lung transplanted patients (mean 2,2 infective episode/patient). One month after transplantation, 20% and 60% of the patients who underwent respectively heart and heart-lung transplantation, showed at least one episode of severe infection. Mortality related to infections was 11% (2/17) in heart transplanted children, and 25% (1/4) in those heart-lung transplanted. There was no premature death, within the first month after transplant. Infections with bacteria etiology were the most frequent in both groups, 68% (heart transplanted children) and 36% (heart-lung transplanted children). Most of our patients were HCMV infected, 43% and 100% respectively from the first and the second group. The lung was the most infected organ in infections, 56% and 100% of all episodes in the two groups. Heart transplantation, finally, is a reality in children with congenital or acquired heart disease, untreatable with conventional surgery. Heart-lung transplantation, even if possible in pediatric patients, is still to be considered an option, in very serious conditions.