From 1986 to February 1993, 40 children aged 2 months to 18 years (average age 10.4 ± 5.8 years) underwent heart transplantation. Indications for transplantation were idiopathic cardiomyopathy (52%), congenital heart disease (35%) with and without prior repair (71% and 29%, respectively), hypertrophic cardiomyopathy (5%), valvular heart disease (3%), and doxorubicin cardiomyopathy (5%). Patients were managed with cyclosporine and azathioprine. No prophylaxis with antilymphocyte globulin was used. Steroids were given to 39% of patients for refractory rejection, but weaning was always attempted and generally successful (64%). Five patients (14%) received maintenance steroids. Four patients died in the perioperative period and one died 4 months later. There have been no deaths related to rejection or infection. Average follow-up was 36 ± 19 months (range 1 to 65 months). Cumulative survival is 88% at 5 years. In patients less than 7 years of age, rejection was monitored noninvasively. In the first postoperative month, 89% of patients were treated for rejection. Freedom from serious infections was 83% at 1 month and 65% at 1 year. Cytomegalovirus infections were treated successfully with ganciclovir in 11 patients. No impairment of growth was observed in children who underwent transplantation compared with a control population. Twenty-one patients (60%) have undergone annual catheterizations and no sign of graft atherosclerosis has been observed. Seizures occurred in five patients (14%) and hypertension was treated in 10 patients (28%). No patient was disabled and no lymphoproliferative disorder was observed. When this group was compared with 87 heart transplant recipients who were more than 50 years of age and receiving no maintenance steroids, a better postoperative survival rate was found (97% vs 84%; p < 0.05). Our experience suggests that immunosuppression without maintenance steroids might improve the prospects for prolonged survival in the pediatric age group. Long-term survivors have an excellent potential for full rehabilitation.

Ferrazzi, P., Fiocchi, R., Gamba, A., Mamprin, F., Senni, M., Glauber, M., et al. (1993). Pediatric heart transplantation without chronic maintenance steroids. THE JOURNAL OF HEART AND LUNG TRANSPLANTATION, 12(6), 241-245.

Pediatric heart transplantation without chronic maintenance steroids

Senni M;
1993

Abstract

From 1986 to February 1993, 40 children aged 2 months to 18 years (average age 10.4 ± 5.8 years) underwent heart transplantation. Indications for transplantation were idiopathic cardiomyopathy (52%), congenital heart disease (35%) with and without prior repair (71% and 29%, respectively), hypertrophic cardiomyopathy (5%), valvular heart disease (3%), and doxorubicin cardiomyopathy (5%). Patients were managed with cyclosporine and azathioprine. No prophylaxis with antilymphocyte globulin was used. Steroids were given to 39% of patients for refractory rejection, but weaning was always attempted and generally successful (64%). Five patients (14%) received maintenance steroids. Four patients died in the perioperative period and one died 4 months later. There have been no deaths related to rejection or infection. Average follow-up was 36 ± 19 months (range 1 to 65 months). Cumulative survival is 88% at 5 years. In patients less than 7 years of age, rejection was monitored noninvasively. In the first postoperative month, 89% of patients were treated for rejection. Freedom from serious infections was 83% at 1 month and 65% at 1 year. Cytomegalovirus infections were treated successfully with ganciclovir in 11 patients. No impairment of growth was observed in children who underwent transplantation compared with a control population. Twenty-one patients (60%) have undergone annual catheterizations and no sign of graft atherosclerosis has been observed. Seizures occurred in five patients (14%) and hypertension was treated in 10 patients (28%). No patient was disabled and no lymphoproliferative disorder was observed. When this group was compared with 87 heart transplant recipients who were more than 50 years of age and receiving no maintenance steroids, a better postoperative survival rate was found (97% vs 84%; p < 0.05). Our experience suggests that immunosuppression without maintenance steroids might improve the prospects for prolonged survival in the pediatric age group. Long-term survivors have an excellent potential for full rehabilitation.
Si
Articolo in rivista - Articolo scientifico
Scientifica
Adolescent; Azathioprine; Child; Child, Preschool; Cyclosporine; Female; Graft Rejection; Heart Transplantation; Human; Infant; Infection; Male; Postoperative Complications; Steroids; Survival Rate;
English
241
245
5
Ferrazzi, P., Fiocchi, R., Gamba, A., Mamprin, F., Senni, M., Glauber, M., et al. (1993). Pediatric heart transplantation without chronic maintenance steroids. THE JOURNAL OF HEART AND LUNG TRANSPLANTATION, 12(6), 241-245.
Ferrazzi, P; Fiocchi, R; Gamba, A; Mamprin, F; Senni, M; Glauber, M; Troise, G; Parenzan, L
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10281/371472
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