Abstract
Successful infant heart transplantation has now been performed for over 25 years. Assessment of long term outcomes is now possible. We report clinical outcomes for322 patients who received their heart transplant during infancy. Actuarial graft survival for newborn recipients is 59% at 25 years. Survival has improved in the most recent era. Cardiac allograft vasculopathy is the most important late cause of death with an actuarial incidence at 25 years of 35%. Post-transplant lymphoma is estimated to occur in 20% of infant recipients by25 years. Chronic kidney disease grade 3 or worse is present in 31% of survivors. The epidemiology of infant heart transplantation has changed through the years as the results for staged repair improved and donor resources remained stagnant. Most centers now employ staged repair for hypoplastic left heart syndrome and similar extreme forms of congenital heart disease. Techniques for staged repair, including the hybrid procedure, are described. The lack of donors is described with particular note regarding decreased donors due to newer programs for appropriate infant sleep positioning and infant car seats. ABO incompatible donors are a newer resource for maximizing donor resources, as is donation after circulatory determination of death and techniques to properly utilize more donors by expanding the criteria for what is an acceptable donor. An immunological advantage for the youngest recipients has long been postulated, and evaluation of this phenomenon may provide clues to the development of accommodation and/or tolerance.
Highlights
Successful infant heart transplantation has been performed for over 25 years
The first successful infant recipient was transplanted by Denton Cooley in 1984 and this child survived 13 years
Though, the proportion of transplant procedures performed for infants with a diagnosis of congenital heart disease has changed from 80% of the total in 1988-1995 to 63% from 1996-2009 [3]
Summary
Successful infant heart transplantation has been performed for over 25 years. Assessment of long term outcomes is possible. The first successful newborn heart recipient was transplanted at Loma Linda in 1985 at the age of 4 days. Though, the proportion of transplant procedures performed for infants with a diagnosis of congenital heart disease has changed from 80% of the total in 1988-1995 to 63% from 1996-2009 [3].
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