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Ann Thorac Surg 2007;84:1640-1644. doi:10.1016/j.athoracsur.2007.05.070
© 2007 The Society of Thoracic Surgeons
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Yanto Sandy Tjang
Ute Blanz
Lech Hornik
Gero Tenderich
Reiner Körfer
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Right arrow Transplantation - heart

Original Articles: Cardiovascular

Heart Transplantation in Children: Clinical Outcomes in a Single Center

Yanto Sandy Tjang, MD, DSca,*, Ute Blanz, MDa, Lech Hornik, MDa, Gero Tenderich, MDa, Michiel Morshuis, MDa, Hans Stenlund, PhDb, Andreas Bairaktaris, MDa, Reiner Körfer, MD, PhDa

a Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center, North Rhine Westphalia/University Hospital of Bochum, Bad Oeynhausen, Germany
b Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

Accepted for publication May 29, 2007.

* Address correspondence to Dr Tjang, Wielandstrasse 11, Bad Oeynhausen, 32545, Germany (Email: ystjang{at}hotmail.com).

Background: Despite being accepted as the best treatment for end-stage heart diseases, the long-term benefit of heart transplantation in children remains a matter of controversial debate. This study aimed to evaluate our clinical experience with heart transplantation in children.

Methods: From March 1989 to December 1999, 93 consecutive orthotopic heart transplantations in children (less than 18 years of age) were performed at the Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW in Bad Oeynhausen, Germany. Clinical data were retrieved from a computerized database. Follow-up information was 100% completed.

Results: The main indications for heart transplantation were dilated cardiomyopathy (68%) and congenital heart disease (31%). Early mortality risk was 14% ± 3.6%. Primary graft failure (39%) was the main cause of early death. Total follow-up time was 694 patient-years (mean, 104.1 ± 42.8 months). Twenty-three patients died during follow-up, resulting in 33 of 1,000 patient-years of late mortality rate. Acute rejection (43%) and allograft vasculopathy (26%) were attributed to late mortality. The 1-, 5-, 10-, and 15-year survival was 83%, 74%, 63%, and 50%, respectively. Recipient age less than one year (p = 0.02) and ischemia time greater than 300 minutes (p = 0.04) were associated with decreased survival. Social activities at the end of follow-up were school (69%), working (19%), and at home (12%).

Conclusions: Heart transplantation is a rational and durable treatment option for children with end-stage heart diseases. The long-term outcomes and quality of life after heart transplantation in children are encouraging.






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