Cardiac Transplantation in Children

Abstract

HISTORICAL OVERVIEW In 1967, Dr Christian Barnard1 captured the imagination of the world's lay and medical communities when he performed the first human orthotopic cardiac allotransplant. Although the recipient survived for only 17 days, even this limited success spurred many centers around the world to attempt heart transplantation in the late 1960s and early 1970s. Interestingly, Dr Adrian Kantrowitz2 in Brooklyn, NY, had attempted a human neonatal cardiac transplantation nearly coincidentally with Dr Barnard's historic operation; the neonate survived only a few hours. Because of poor results secondary to rejection, infection, and donor shortage, most centers had abandoned their heart transplantation programs by the middle 1970s. Experience at the few centers that persisted with heart transplantation, Stanford University being the most notable, led to improved candidate selection and improved immunosuppression. The introduction of endomyocardial biopsy in 19733 for the diagnosis of rejection also contributed substantially to improved understanding and management of this complication. In the late 1970s, encouraging results from Stanford prompted renewed interest in the procedure. However, pediatric experience, even at Stanford, was limited to a small number of adolescents during the 1970s. In 1980, the introduction of a new maintenance immunosuppressive drug, cyclosporine A, led to improved survival because of less infection and better management of the rejection process.