Heart transplantation in neonates and in children

C. L. Backer, V. R. Zales, F. S. Idriss, P. Lynch, S. Crawford, D. W. Benson, Constantine Mavroudis

Research output: Contribution to journalArticle

Abstract

Between May 1988 and July 1991, 28 neonates and children underwent orthotopic heart transplantation at Children's Memorial Hospital in Chicago. Indications for heart transplantation were hypoplastic left heart syndrome (10), dilated cardiomyopathy (13), aortic stenosis with endocardial fibroelastosis (1), complex D-transposition of the great arteries after Senning repair (1), L-transposition of the great arteries with single ventricle after shunt (1), cor biloculare, pulmonary atresia, and situs inversus after Fontan (1), and chronic rejection after heart transplantation for hypoplastic left heart syndrome (1). The age at time of transplantation ranged from 2 days to 17 years (mean, 5.3 ± 6.1 years). Early deaths were from intraoperative donor right ventricular failure (2) and acute rejection after a second transplant procedure at 21 days (1), for an in-hospital mortality rate of 10.7%. Immunosuppression was with cyclosporine, azathioprine, and prednisone, with an attempt to discontinue the prednisone in neonates at age 6 months as guided by endomyocardial biopsy. Rejection episodes were treated with methylprednisolone pulse (34) or with OKT3 (4). Endomyocardial biopsy (in patients older than 6 months) was used extensively, and acute rejection was diagnosed in 29 of 301 biopsies. Three late deaths occurred (mean follow-up, 16.3 ± 11.8 months): one of acute rejection at 13 months, one of viral pneumonia at 7 months, and one of intraabdominal sepsis as a complication of peritoneal dialysis at 5 months. Actuarial survival at 2 years is 77% ± 9% (standard error of the estimate). Heart transplantation for neonates and for children can be performed with acceptable operative mortality. Intermediate results with triple therapy immunosuppression and an intensive rejection surveillance regimen relying on endomyocardial biopsy are encouraging.

Original languageEnglish (US)
Pages (from-to)311-319
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume11
Issue number2 I
StatePublished - Jan 1 1992
Externally publishedYes

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Heart Transplantation
Newborn Infant
Hypoplastic Left Heart Syndrome
Biopsy
Transposition of Great Vessels
Prednisone
Immunosuppression
Endocardial Fibroelastosis
Viral Pneumonia
Situs Inversus
Pulmonary Atresia
Muromonab-CD3
Mortality
Aortic Valve Stenosis
Methylprednisolone
Azathioprine
Dilated Cardiomyopathy
Peritoneal Dialysis
Hospital Mortality
Cyclosporine

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Backer, C. L., Zales, V. R., Idriss, F. S., Lynch, P., Crawford, S., Benson, D. W., & Mavroudis, C. (1992). Heart transplantation in neonates and in children. Journal of Heart and Lung Transplantation, 11(2 I), 311-319.

Heart transplantation in neonates and in children. / Backer, C. L.; Zales, V. R.; Idriss, F. S.; Lynch, P.; Crawford, S.; Benson, D. W.; Mavroudis, Constantine.

In: Journal of Heart and Lung Transplantation, Vol. 11, No. 2 I, 01.01.1992, p. 311-319.

Research output: Contribution to journalArticle

Backer, CL, Zales, VR, Idriss, FS, Lynch, P, Crawford, S, Benson, DW & Mavroudis, C 1992, 'Heart transplantation in neonates and in children', Journal of Heart and Lung Transplantation, vol. 11, no. 2 I, pp. 311-319.
Backer CL, Zales VR, Idriss FS, Lynch P, Crawford S, Benson DW et al. Heart transplantation in neonates and in children. Journal of Heart and Lung Transplantation. 1992 Jan 1;11(2 I):311-319.
Backer, C. L. ; Zales, V. R. ; Idriss, F. S. ; Lynch, P. ; Crawford, S. ; Benson, D. W. ; Mavroudis, Constantine. / Heart transplantation in neonates and in children. In: Journal of Heart and Lung Transplantation. 1992 ; Vol. 11, No. 2 I. pp. 311-319.
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abstract = "Between May 1988 and July 1991, 28 neonates and children underwent orthotopic heart transplantation at Children's Memorial Hospital in Chicago. Indications for heart transplantation were hypoplastic left heart syndrome (10), dilated cardiomyopathy (13), aortic stenosis with endocardial fibroelastosis (1), complex D-transposition of the great arteries after Senning repair (1), L-transposition of the great arteries with single ventricle after shunt (1), cor biloculare, pulmonary atresia, and situs inversus after Fontan (1), and chronic rejection after heart transplantation for hypoplastic left heart syndrome (1). The age at time of transplantation ranged from 2 days to 17 years (mean, 5.3 ± 6.1 years). Early deaths were from intraoperative donor right ventricular failure (2) and acute rejection after a second transplant procedure at 21 days (1), for an in-hospital mortality rate of 10.7{\%}. Immunosuppression was with cyclosporine, azathioprine, and prednisone, with an attempt to discontinue the prednisone in neonates at age 6 months as guided by endomyocardial biopsy. Rejection episodes were treated with methylprednisolone pulse (34) or with OKT3 (4). Endomyocardial biopsy (in patients older than 6 months) was used extensively, and acute rejection was diagnosed in 29 of 301 biopsies. Three late deaths occurred (mean follow-up, 16.3 ± 11.8 months): one of acute rejection at 13 months, one of viral pneumonia at 7 months, and one of intraabdominal sepsis as a complication of peritoneal dialysis at 5 months. Actuarial survival at 2 years is 77{\%} ± 9{\%} (standard error of the estimate). Heart transplantation for neonates and for children can be performed with acceptable operative mortality. Intermediate results with triple therapy immunosuppression and an intensive rejection surveillance regimen relying on endomyocardial biopsy are encouraging.",
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