Short and mid-term results of heart-lung transplantation in children:: a single center experience

Introduction: For end-stage cardiopulmonary disease in childhood combined heart-lung transplantation may be the only therapeutic option. Patients: Seven children with end-stage cardiac pulmonary disease (5 primary and 1 secondary pulmonary hypertension, 1 pulmonary atresia with VSD) underwent heart-lung transplantation between 1992 and 1998. Average recipient age was 9 7/12 years (2 3/12 - 14 5/12 years). All children were orthopnoec, syncopal, oxygen- or ventilator-dependent prior to transplantation. Results: All children survived transplantation. Average ventilation period was 23 days (1-76 days). Follow-up period was 8 to 56 months (35.7 months). One child died 48 months after transplantation due to Aspergillus infection. Cyclosporine or Tracrolimus, and Azathioprine or Mycofenolatmofetil and steroids were used for immunosuppression. Acute lung-rejection was observed in 4, and acute heart-rejection in 2 patients. Three children suffered from bronchiolitis obliterans syndrome and one underwent a single lung retransplantation 42 months after transplantation. Complications had to be divided in surgical, infectious, drug-related and other com plications. After their discharge from the hospital all the patients resumed to almost normal physical activity and life style. Conclusion: Heart-lung transplantation is a therapeutic option in end-stage cardiac pulmonary disease leading to almost normal life. Rejections and complications can be managed successfully. Nevertheless carefull follow-up monitoring is necessary. Limiting factor for long-term survival are stilt bronchiolitis obliterans and infections.