Il trapianto cardiaco in eta pediatrica: Undici anni di esperienza

In 1996, the Thirteenth Official Report of the ISHT Registry reports 1.310 heart transplant to children under 5 years of age and 2.233 in patients under 16 years. Their 3-year actuarial survival rate is about 66%. Contradictory results on morbidity and mortality have been reported. The experience of 'Bambino Gesu' Hospital during the decade 1986-1996 is reported. From November 1985 up to December 31, 1996 128 patients (64 males, 64 females) with an age ranging from 1 day to 18 years (mean age 4,7 yrs, median 3 yrs) have been listed for heart transplant. Nine patients were removed from the list for various reasons, 10 are at present in the waiting list, 47 (36.1%) died after a mean wait of 3.1 months, 62 underwent transplant after a mean wait of 4 months. Two patients underwent retransplantation, both six years after the first transplant. The 64 transplanted patients: (including the 2 retransplants) had a mean age of 61 months; 10 patients were under 1 year of age. Their indications were: cardiomyopathy in 46 patients, congenital heart defects in 18. The 1-, 5-, and 11 year actuarial survival rate for the 64 patients who underwent heart transplantation is 68%, 62%, and 42%, respectively. The 5- and 11- year actuarial survival rate for the 43 patients with a survival of more than 1 year is 93% and 63%, respectively. The follow-up of the 64 patients ranges from 0 to 132 months, with a mean follow-up of 39 months. The overall survival is 60%. 14 patients died peri-operatively. Causes of late deaths were: acute rejection during the first year in three patients, and infection in four (fungine in 2 and viral in 2); after the first year, 2 patients died of chronic rejection (both patients were listed for re-transplantation), two died for family non compliance and one of a rare metabolic disease. At present, 36 patients, included the 2 retransplanted ones, are alive. 32 of them have normal growth, development, and neurologic outcome. We conclude that heart transplant may give a good intermediate and long-term survival in selected pediatric patients; the extension of indications may bring to less encouraging results, but should not be definitely excluded. Apart from the surgical risk, patients transplanted for congenital heart diseases may have a more favourable long-term follow-up compared to that of patients transplanted for various forms of cardiomyopathies.