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OUTCOMES OF PEDIATRIC ORTHOTOPIC HEART TRANSPLANTATION IN WESTERN CANADA

K Myers, B Laing, JY Coe, DB Ross, I Rebeyka, U Boston, L West, D Modry
Edmonton, Alberta

This retrospective study defines the outcomes of the provincial pediatric heart transplant (Tx) program since its inception. The series includes 74 heart and 1 heart-lung Tx in 68 patients age £ 18 years (Group 1) as well as 8 patients transplanted elsewhere but followed at this hospital (Group 2) since 1987. Mean age at Tx was 7.9 ± 6.2 (range 0-17.4) years for Group 1 and 12.2 ± 10.6 (range 2.5-18.5) years for Group 2. Two patients listed in utero were successfully transplanted. Five infants received ABO-mismatched grafts. Triple immunosuppression included tacrolimus, mycophenylate and prednisone. All patients remained on maintenance steroid therapy for 9 to 15 months. Tacrolimus levels were maintained at 10-15 µg/L for the first year post- Tx, and 8-10 µg/L thereafter. Surveillance endomyocardial biopsies were performed at 3, 6 and 12 months, then yearly. Overall survival at 1, 5 and 10 years was 83%, 67% and 56% respectively. Since 1996, 1 and 5 year survival improved to 88% and 84% respectively (n=53). Fifty patients (73.5%) are currently alive in Group 1 and 6 patients in Group 2. Seven patients were retransplanted for Tx vasculopathy (TCAD) (n=6) and graft failure (n=1). Six patients developed post-Tx lymphoproliferative disorder (PTLD), of which 2 died. Patients died from TCAD (n=2), non-compliance (n=8), infection (n=2), PTLD (n=2), and graft failure (n=3).
Despite a less aggressive surveillance protocol and higher immunosuppression targets, rates of PTLD were similar to those reported at other centers. Excluding therapy non-compliance, the worst cellular rejection was £ Grade 1b (ISHLT). Early and mid-term results of pediatric heart transplantation continue to improve.
DNC

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