Thorac Cardiovasc Surg 2012; 60 - V36
DOI: 10.1055/s-0031-1297426

Indications for pediatric heart-lung transplantation in the era of advanced congenital heart surgery

H Niehaus 1, A Simon 2, M Strüber 3, C Müller 4, M Ono 3, A Haverich 3, J Cremer 1, G Warnecke 3
  • 1Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Herz- und Gefäßchirurgie, Kiel, Germany
  • 2Harefield Hospital, Cardiac Surgery, London/Harefield, United Kingdom
  • 3Hannover Medical School, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover, Germany
  • 4Hannover Medical School, Department of Pediatric Pneumology and Neonatology, Hannover, Germany

Objective: In the era of advanced pediatric cardiac surgery and advanced medical treatment of pulmonary hypertension, the number of heart-lung transplantations in the pediatric age group is constantly decreasing. We report our institutional experience.

Methods: We reviewed all patients below the age of 18 who underwent heart-lung transplantation at our institution. We analyzed indications for transplantation, survival and causes of death comparing different eras of transplantation.

Results: 19 patients below the age of 18 underwent heart-lung transplantation at our institution, 13 of which have been transplanted during the past 10 years. Underlying diagnoses were Eisenmenger's syndrome (n=6), pulmonary diseases such as lung hypoplasia, alveolar proteinosis, intrapulmonary fistulas (n=3), s.p. chemotherapy (n=2), combined cardiac and pulmonary diseases such as dilative or restrictive cardiomyopathy in combination with primary pulmonary hypertension (n=3), isolated primary pulmonary hypertension (n=3) and others (n=2). There was a shift from Eisenmenger's syndrome to other diagnoses. Two patients died early. Kaplan-Meier survival rates at 1, 3 and 5 years were 33, 33 and 0% in the early era versus 92, 83 and 69% more recently (p<0.001). Causes of deaths were early graft failure (n=2) as well as pneumonia (n=2), acute rejection (n=2), chronic rejection (3), and PTLD (n=1).

Conclusions: Pediatric heart-lung transplantation has become a rare procedure for few selected indications. However, for these patients it remains the only treatment option. The shift of underlying diagnoses may have a positive impact on short and long term outcome.