LONGTERM FOLLOW-UP MORE THAN 5 YEARS AFTER PEDIATRIC HEART TRANSPLANTATION

E. Knyphausen. M. Ertel, M.M. Kömer*. T. Breymann*, K. Minami*, W.R. Thies, H. Meyer, R. Körfer*.

Heart Center of Northrhine-Westfalia, University-Clinic of the Ruhr-University of Bochum, Dept. of Pediatric Cardiology and Dept. of Thoracic and Cardiovascular Surgery*, Bad Oeynhausen, Germany.

Since 1988 86 children (p.) underwent orthotopic heart transplantation (HTx) at our institution. 33 p. survived more than 5 years (median age 10.6 y., median follow-up 7.5 y.). 2 p. of this selected group died between 6 and 6.5 years after HTx. Systolic heart function was satisfactory in nearly 85% (EF >32%). in 15% it was slightly decreased. According to Doppler echocardiographic measurements of the mitral valve flow and left ventricular enddiastolic pressure (LVEDP) diastolic function was decreased in 74% (33% LVEDP 12-15 mmHg and 41% LVEDP >15 mmHg vs. 26% LVEDP <12 mmHg). The latest angiograms showed mild narrowing of the coronary arteries or other abnormalities in 16%. About 80% of our p. were free from rejections during the follow-up period. Currently one third of our p. are treated with a CSA monotherapy, 61% p. with a double drug and triple drug therapy resp. (CSA + azathioprine, CSA + azathioprine + prednisolone resp.). 1 p. was switched to tacrolimus therapy. Spiroergometric examinations revealed good exercise tolerance in most p.. Side effects of the immunosuppressive medication were dominated by CSA-correlated nephrotoxicity, 37% p. must be treated for arterial hypertension, in 1 p. lymphoproliferative disease was detected. 74% p. suffered from infections only 1 to 3 times a year, 26% p. more than three times a year. The educational situation of our p. is almost normal.

CONCLUSIONS: Apart from some complications and medical side effects longterm follow-up of our patients was satisfactory more than 5 years after HTx. Therefor we think that our postoperative results were encouraging.