Pediatric Heart Transplantation in a National Pediatric Hospital in Argentina

Abstract

Background Heart transplantation is the most appropriate surgical option for terminal heart failure in childhood. The lack of suitables donors is the biggest problem to develop a Pediatric Heart Transplant Program. Materials and Methods This is a prospective, retrospective, transversal and observational paper. From July 2000, 125 patients have been listed for heart transplantation. Age: 1 to 230 months; Female: 52%; Male: 48%. Range in waiting list: 1 to 3351 days. Diagnosis: Dilated Cardiomyopathy 91; Congenital Heart Disease 18; Restrictive Cardiomyopathy 13; Pulmonary Hypertension 2; Retransplant 1. Results Three patients (16,32,7 months old) were transplanted with an ABO incompatible heart donor using the "West Protocol". Due to the lack of suitable donors and its consequence of higth mortality on waiting list, in 2006 we have started to use Mechanical Assitance to let patients, in terminal condition, survive and have a chance for transplantation. Fifty-seven heart transplants were done in 56 patients. The actuarial survival rate in waiting list showed a huge improvement with the use of the Mechanical Cardiac Support (MCS); 27 patients were assisted with the MCS before transplantation. Age: 13 to 198 months;weight: 6 to 90,0 kg.; univentricular MCS: 14 (54%) and biventricular MCS: 13 (46%). No surgical deaths and no REDO because surgical bleeding in the MSC series. Five patients were assited with ECMO after transplantation, due to primary organ failure; with good results in all of them after ECMO weanning. The triple scheme therapy for immunosuppression was:azathioprine, cyclosporine and steroids. Conclusion A Heart Transplant Program in a Pediatric Public Hospital; in Argentina; provides the opportunity for heart transplantation to infants and pediatric population with terminal heart failure.