Outcome of Paediatric Cardiac Re-Transplantation in the Mechanical Support Era

Abstract

<h3>Purpose</h3> To review the outcome of paediatric cardiac re-transplantation (reOHTx) in the mechanical cardiac support (MCS) era. <h3>Methods</h3> A retrospective study of patients less than 18 years of age who underwent reOHTx in our Institution. Data were obtained from departmental databases and hospital medical records. <h3>Results</h3> From 1987 to 2021, 21 patients underwent reOHTx. Diagnoses leading to first transplant were dilated cardiomyopathy in 12 (10 idiopathic, 1 post-chemotherapy, 1 related to viral myocarditis), restrictive cardiomyopathy in 1, hypertrophic cardiomyopathy in 1 and congenital heart disease in 7 patients. Mean age at first OHTx was 8 years. Prior to primary transplant, one patient was supported with Levitronix Centrimag LVAD, one with BIVAD, a child with VA-ECMO followed by Berlin Heart EXCOR LVAD and one child with VA-ECMO only. Mean time course between first and second OHTx was 82 months. Eleven patients were mechanically supported as a bridge to reOHTx: 8 with Levitronix Centrimag BIVAD (2 from VA-ECMO), 4 with VA-ECMO, 2 with Berlin Heart EXCOR BIVAD, 2 with Berlin Heart EXCOR LVAD and 1 with Heartware. Mean time on support was 54 days (1-275). There was only one early death after reOHTx. This patient received the second heart 8 days after the first transplant and died from 2 days post reOHTx due to brain hemorrhage. One patient required 2 VA-ECMO runs due to acute graft failure. Two patients required VA-ECMO post reOHTx. Eight patients required renal replacement therapy. Five suffered a cerebrovascular accident. Mean follow up is 112 months. There were 7 late deaths in this period of 34 years, 2 of them related to rejection due to poor compliance with immunosuppressive treatment. <h3>Conclusion</h3> Re-transplantation in children carries a very good outcome. With mechanical cardiac support we can bridge children to reOHTx more effectively. Furthermore, MCS can be also used in acute graft failure or for immunological manipulation in acute rejection.