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CARDIOVASCULAR
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Volume 5, 2000, No 4 |
Long-term
Survivors (Longer than 5 Years) after Pediatric Heart Transplantation with
Reduced Immunosuppression Therapy
K. Minami, Y. Bonkohara, E. zu Knyphausen, G. Tenderich, U.
Blanz, T. Breymann, N. Reiß, D. Böthig, H. Meyer, R. Körfer
Background:
Pediatric
heart transplantation has recently become an accepted method of treatment for
end-stage pediatric heart disease. However,
the long-term result is still an interesting issue, especially in point of
allograft function, complications of immunosuppression, and quality of life in
long-term survivors.
Methods:
From
March 1989 through 1999, 83 patients (< 16 years) underwent heart
transplantation in our institute. Of
these patients, we focused on 33 patients who have survived more than 5 years
from transplantation and examined shortening fraction of the left ventricle,
left ventricular enddiastolic pressure by echocardiography, coronary angiogram,
complications of immunosuppression, and their daily lives.
Results:
The 1-,
3-, 5-year actuarial survival rates were 81%, 78%, and 74% respectively.
The function of the left ventricle was normal in most patients, however,
16% of them had mild narrowing or other abnormalities of coronary arteries.
Eighty-one percent of long-term survivors were steroid-free, 31% with
cyclosporine monotherapy, and 44% with cyclosporine and azathioprine double drug
therapy.
Nephrotoxicity was the most common complication of immunosuppression, however,
none of them had critical renal dysfunction.
Almost all patients are doing age appropriate activities.
Conclusion:
The
long-term results of pediatric heart transplantation are satisfactory.
However, renal dysfunction caused
by immunosuppression can be aggravated after 10 years from heart transplantation.
(CVE. 2000; 5 (4): 248-252)
Key words: pediatric heart transplantation, long-term survivor, allograft function, posttransplant coronary artery disease, immunosuppression, quality of life
Kazutomo
Minami, M.D., Ph.D.
Herzzentrum NRW
Klinik für Thorax- und Kardiovaskularchirurgie
Georgstr.11
D-32545 Bad Oeynhausen
Germany
E-mail: kminami@mailman.hdz-nrw.ruhr-uni-bochum.de
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