Paediatric cardiac transplant surgery has improvedBMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7188.944 (Published 03 April 1999) Cite this as: BMJ 1999;318:944
- C Wigfield, Paediatric cardiac surgical fellow (, )
- H C Leonard, Specialist registrar paediatric cardiology,
- J R L Hamilton, Consultant paediatric cardiac surgeon,
- A Hasan, Consultant paediatric cardiac surgeon,
- J H Dark, Consultant in cardiothoracic surgery
EDITOR—Kelly and Mayer's editorial highlights current issues in paediatric transplantation.1 We think that the survival figures quoted for heart transplantation in children under the age of 6 are unduly pessimistic (60% at two years—figures for 1992 cited); they do not reflect recent improvements in this group.
The intermediate results (two year actuarial survival) quoted for the American transplantation registry in 1996 for this group of patients was 75%.2 A multi-institutional study confirmed these findings.3 Mitchell et al reported the outcome specifically for infants under 6 months and established actuarial survivals of 80%, 78% and 70% at one, two, and three years respectively in 51 consecutive patients.4 The Loma Linda group reports early mean actuarial survival of 80-90% and five year survival of 70-80%.5
In the past 11 years we have given transplants to 63 children under 16 with a median age at transplantation of 4.6 years. The actuarial survival at two years is 87% and at 10 years 82%. The survival was not significantly different in children under and over 6 (85% and 90% respectively at two years).
These improved intermediate results reflect the experience gained in patient management in paediatric cardiac transplant surgery rather than altered selection criteria. It may be appropriate to consider transplantation rather than high risk palliative surgery for some patients with complex congenital heart disease. Achieving intermediate results comparable to those seen with adult cardiac transplantation has been encouraging.