| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1990;49:385-390
© 1990 The Society of Thoracic Surgeons
a Departments of Pediatrics, Surgery, and Medicine, University of Minnesota Hospital and Clinic, Minneapolis, Minnesota, USA
b Departments of Pediatrics, Surgery, and Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
* Address reprint requests to Dr Braunlin, University of Minnesota, Box 94, 420 Delaware St SE, Minneapolis, MN 55455.
Cardiac transplantation has only recently become an accepted therapeutic modality for children and adolescents with end-stage cardiomyopathy. Long-term survival, the incidence of rejection, and the incidence of infection are still being defined. From 1985 to 1989, 21 children aged 6 months to 19 years (average age, 11.2 years) underwent cardiac transplantation at our institutions. Eighteen survived the operative period and have been followed for 5 to 49 months (average follow-up, 24 months). All operative survivors have received tripledrug immunosuppression consisting of cyclosporine, azathioprine, and prednisone. During follow-up, 7 patients have been treated on 12 occasions for rejection as documented by endomyocardial biopsy. Eight (67%) of the 12 episodes of rejection occurred in the presence of subtherapeutic cyclosporine levels. Two of the 7 patients treated for rejection have subsequently died of ongoing cardiac rejection and arrhythmia. There have been no perioperative or late deaths from infection. Bacterial sepsis was identified and treated twice during follow-up, viral infections on five occasions, and fungal infection once. Actuarial 1-year survival and 3-year survival of the 18 operative survivors are 94% and 78%, respectively. In the first 7 months after cardiac transplantation, 73% of patients were free from rejection and 83% were free from serious bloodborne infection. We conclude that (1) the incidence of rejection and infection is low with tripledrug immunosuppression; (2) rejection episodes occur must commonly within the first year after cardiac transplantation but can occur late; (3) rejection can often be associated with subtherapeutic cyclosporine levels; (4) major bacterial infection can occur in association with a common disease process but appears to respond to standard antibiotic therapy; and (5) viral infections have been well tolerated by the patients.
This article has been cited by other articles:
|
|
 |
|
  Y. S. Tjang, U. Blanz, L. Hornik, G. Tenderich, M. Morshuis, H. Stenlund, A. Bairaktaris, and R. Korfer Heart Transplantation in Children: Clinical Outcomes in a Single Center Ann. Thorac. Surg., November 1, 2007; 84(5): 1640 - 1644. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Fullerton, D. N. Campbell, S. D. Jones, J. Jaggers, J. M. Brown, M. M. Wollmering, F. L. Grover, C. Mashburn, M. Luna, H. M. Sondheimer, et al. Heart transplantation in children and young adults: Early and intermediate-term results Ann. Thorac. Surg., April 1, 1995; 59(4): 804 - 812. [Abstract] [PDF]
|
|
|
|
|
|
D. G. Pennington, N. Noedel, L. R. McBride, K. S. Naunheim, and W. S. Ring Heart transplantation in children: An international survey Ann. Thorac. Surg., September 1, 1991; 52(3): 710 - 715. [Abstract] [PDF]
|
|
|
|
|
|
F. W. Hehrlein, H. Netz, R. Moosdorf, F. Dapper, H. H. Scheld, J. Bauer, and J. Boldt Pediatric heart transplantation for congenital heart disease and cardiomyopathy Ann. Thorac. Surg., July 1, 1991; 52(1): 112 - 117. [Abstract] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
