Harttransplantatie bij kinderen

Objective

To describe the outcome among children who were evaluated during the period 1998-2007 in the only Dutch paediatric heart transplantation programme.

Design. Descriptive, retrospective.

Method

Details were studied of patients under 18 years of age who had been evaluated for possible heart transplant in the Erasmus MC-Sophia children’s hospital in Rotterdam during the period 1 January 1998-31 December 2007. The study outcomes were defined as follows: date of transplant or death, or the physical condition of the patient on 31 December 2007.

Results

Data from 64 children were evaluated; the mean age was 7 years (SD: 6). Cardiomyopathy was the most common cause of heart failure (n = 55; 86%). There was (as yet) no indication for heart transplantation in 19 children (30%); there was an indication for heart transplantation in 45 children. Mechanical support by extracorporeal membrane oxygenation or a ventricular assist device was used in 7 patients. 26 children of the 45 children with an indication for transplantation were put on the waiting list and 13 of these underwent a successful heart transplant at a mean age of 9 years (SD: 5) after a mean waiting time of 9 weeks (SD: 8), 12 within the Rotterdam centre and 1 abroad. 1 patient died within 1 year due to rejection and infections, the other 12 were in good physical condition at the last check-up, on average 4 years (SD: 2) after the transplant. Among the children on the waiting list, 8 died after an average of 22 weeks (SD: 23), 1 was removed from the list because of clinical improvement, and at the end of 2007 4 were still awaiting a donor heart. The other eligible children had not (yet) been placed on the waiting list because parents decided against transplantation (8 children; mean age: 2 years (SD: 2)), because of contraindications (n = 4) or because investigations had not yet been completed (n = 7).

Conclusion

All but one of the 13 children who underwent heart transplantation survived in good physical condition. The heart transplantation programme for children, whereby mechanical support can also be employed, offers selected children the opportunity to dramatically improve their clinical condition and chances of survival.