Survival good 15 years after pediatric heart transplants

More than half of a group of infants and children who underwent heart transplantation at a California hospital starting in 1985 survived at least 15 years after surgery, according to research presented at the annual meeting of the Society of Thoracic Surgeons in Orlando, Fla.

Of the 337 patients who received heart transplants at Loma Linda University Medical Center in Loma Linda, Calif., since 1985, 183 were alive at least 15 years later and 151 are still alive and experiencing good outcomes.

In a press conference discussing some of the conference’s research highlights, lead investigator Hannah Copeland, MD, of Loma Linda University Medical Center discussed data from the study. She and her colleagues reviewed medical records of the 337 patients and assessed demographics before and after transplant.

The most common pre-transplant diagnosis was hypoplastic left heart syndrome. Palliative procedures occurred in 65 patients, and the most common was Blalock-Taussig shunt surgery. Simultaneous reconstructive procedures took place in 115 patients, and the most common was aortic arch reconstruction.

The surviving patients have an average ejection fraction of more than 62 percent. Of the 183 who survived at least 15 years, 36 needed a second transplant and four needed a third. The most common reasons for additional transplantation were graft vasculopathy (83.3 percent) and graft failure (16.7 percent). Immunosuppressive therapy for the surviving patients includes monotherapy (25 patients), dual therapy (87 patients), triple therapy (24 patients) and quadruple therapy (five patients).

Renal insufficiency or renal failure was diagnosed in 99 patients, and 17 of these patients had a kidney transplant. Thirty-eight patients required dialysis at some point after the transplant. The most common cause of death in this group of patients was graft vasculopathy (34.3 percent).

Copeland explained during the press conference that one of the limitations of their study is the fact that the transplant landscape was different in 1985. The average wait time for a heart was 20 days; now, children in need of transplants may wait several months.

She also explained that today, patients waiting for transplants undergo more palliative surgical procedures, which may sensitize them and suggest they may be sicker. 

However, Thomas L. Spray, MD, of the Children’s Hospital of Philadelphia and a discussant at the press conference, said that despite the limitations, the study results suggest that pediatric heart transplantation offers children who need it a chance at a good life.

“Graduation from high school is not unreasonable and college is not unreasonable,” he said.