Evaluation of a cardiac transplanted children cohort: Long term pediatric follow-up and transiant to adulthood, twenty years of monocentric experience

Abstract

Pediatric heart transplantation is commonly performed as a last resort treatment for severe heart dysfunction. We analyzed our 20 years’ experience with pediatric heart transplant: long-term outcomes and fate at transition to adulthood. Retrospective analysis of all children (< 18 years) who underwent heart transplantation between 01-1999 and 12-2018. Demographic data of donors and recipients, etiology, time on waiting list, hemodynamic data, post-transplantation complications, long-term survival of patient and transplant were collected. 49 transplants were performed in 48 children at median age and weight of 8,3 years [2,9–13,5] and 20,5 kg [13,2–39,5]. 86% had cardiomyopathy (dilated in 57% of those), 8% congenital heart disease and 6% myocarditis. Median time on waiting list was 46 days [19–132] with a trend to increase with time. Global survival reached 88% at 1 year and 80% at 5 years post-transplantation. No death nor organ failure occurred for patients transplanted after January 2011. 9(18%) patients died, 6(67%) for transplant failure, 2(22%) for septic shock, 1 for post-operative cerebral hypoxia. Graft rejections occurred 32 times in 17(35%) patients. 8(47%) patients of them were symptomatic, a median of 16 months [6-30] after transplant. 1 patient underwent a second combined heart-kidney transplant, 1 had lymphoma. Median age of transition to adult care was 17,9 years [16,5–18,4] after a mean pediatric care of 6,9 years (0,4 to 19,2). Global median follow-up was 3,8 years [1,5–7,9]. At latest follow-up, 36(74%) children had normal schooling, 7(14%) had some school adaptations, 1 was in a special institution and 1 did not attend school. Our retrospective analysis shows good survival, when compared to current reported data (ISHLT) with normal schooling in 75% of the children, compared to 94% in the normal french population. Quality of life and exercise capacity are currently being studied in our cohort.