Primary Transplantation for Congenital Heart Disease in the Neonatal Period: Long-term Outcomes.

Autor:	John MM; Department of Cardiothoracic Surgery, Loma Linda University, Loma Linda, California., Razzouk AJ; Department of Cardiothoracic Surgery, Loma Linda University, Loma Linda, California. Electronic address: arazzouk@llu.edu., Chinnock RE; Department of Pediatrics, Loma Linda University, Loma Linda, California., Bock MJ; Department of Pediatrics, Loma Linda University, Loma Linda, California., Kuhn MA; Department of Pediatrics, Loma Linda University, Loma Linda, California., Martens TP; Department of Cardiothoracic Surgery, Loma Linda University, Loma Linda, California., Bailey LL; Department of Cardiothoracic Surgery, Loma Linda University, Loma Linda, California.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2019 Dec; Vol. 108 (6), pp. 1857-1864. Date of Electronic Publication: 2019 Jul 27.
DOI:	10.1016/j.athoracsur.2019.06.022
Abstrakt:	Background: Primary transplantation was developed in the 1980s as an alternative therapy to palliative reconstruction of uncorrectable congenital heart disease. Although transplantation achieved more favorable results, its utilization has been limited by the availability of donor organs. This review examines the long-term outcomes of heart transplantation in neonates at our institution. Methods: The institutional pediatric heart transplant database was queried for all neonatal heart transplants performed between 1985 and 2017. Follow-up was obtained from medical records and an annually administered questionnaire. Overall survival and time to development of complications were estimated using the Kaplan Meier method. Univariate and multivariate analyses were performed to identify independent predictors of survival. Results: Heart transplantation was performed in 104 neonates. Median age was 17 days. Hypoplastic left heart syndrome (classic or variant) was the primary diagnosis in 77.8% of patients. Survival at 10 years and 25 years was 73.9% and 55.8%, respectively. At 20 years, freedom from allograft vasculopathy and lymphoproliferative disease was 72.0% and 81.9%, respectively. Freedom from re-transplantation was 81.4% at 20 years. Eight patients (7.6%) developed end-stage renal disease. By multivariate analysis, lower glomerular filtration rate and allograft vasculopathy were the only significant predictors of death. Conclusions: Neonatal heart transplantation remains a durable therapy with very acceptable long-term survival. Children transplanted in the newborn period have the potential to reach adulthood with minimal need for reintervention. (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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