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67 - Heart and lung transplantation

from Part VII - Transplantation

Published online by Cambridge University Press:  08 January 2010

By
Thomas Spray  and
Stephanie M. P. Fuller
Edited by
Mark D. Stringer ,
Keith T. Oldham  and
Pierre D. E. Mouriquand
Thomas Spray
Affiliation:
Heart, Lung and Heart Transplant Services, Children's Hospital of Philadelphia, PA, USA
Stephanie M. P. Fuller
Affiliation:
Heart, Lung and Heart Transplant Services, Children's Hospital of Philadelphia, PA, USA
Mark D. Stringer
Affiliation:
University of Otago, New Zealand
Keith T. Oldham
Affiliation:
Children's Hospital of Wisconsin
Pierre D. E. Mouriquand
Affiliation:
Debrousse Hospital, Lyon
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Summary

Introduction

Thoracic organ transplantation is an important treatment option in children with acquired or congenital cardiopulmonary disease. In recent years, there has been considerable improvement in early outcomes following thoracic organ transplantation in children and 1-year survival is similar now to that in adults. Approximately 250 pediatric heart transplants and 60 lung transplants are performed annually in the United States. Thoracic organ transplantation in neonates and infants has been limited by donor availability, and the number of thoracic organ transplants performed each year in children has plateaued. Complications such as acute and chronic rejection, graft coronary artery disease (CAD) or bronchiolitis obliterans, as well as those of immunosuppression, pose serious threats to the long-term success of thoracic organ transplantation in children. Despite these potential impediments, life expectancy and quality of life for patients following transplantation exceed that for patients with end-stage cardiopulmonary disease who are managed medically. This chapter focuses on the clinical aspects of heart and lung transplantation in infants and children including indications, preoperative evaluation, postoperative course and management, complications and long-term outcomes.

Indications

Heart transplantation

As published by the Registry for the International Society for Heart and Lung Transplantation (ISHLT) in the Seventh Official Report in May 2004, the number of pediatric heart transplants has remained relatively constant over the last 10 years (Fig. 67.1). The most common indication for heart transplantation in the neonatal population remains complex congenital heart disease for which no reasonable corrective or palliative surgical therapy is available.

Type
Chapter
Information
Pediatric Surgery and Urology
Long-Term Outcomes
 , pp. 897 - 912
Publisher: Cambridge University Press
Print publication year: 2006

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References

Boucek, M. M., Edwards, L. B., Keck, B. M.et al.The Registry of the International Society for Heart and Lung Transplantation: Seventh Official Pediatric Report – 2004. J. Heart and Lung Transpl. 2004; 23:933.CrossRefGoogle ScholarPubMed
Cooper, M. M., Fuzesi, L., Addonizio, L. I.et al.Pediatric heart transplantation after operations involving the pulmonary arteries. J. Thorac. Cardiovasc. Surg. 1991; 102:386.Google ScholarPubMed
Lewis, A. B.Prognostic value of echocardiography in children with idiopathic dilated cardiomyopathy. Am. Heart J. 1994; 128:133.CrossRefGoogle ScholarPubMed
Wiles, H. B., McArthur, P. D., Taylor, A. B.et al.Prognostic features of children with idiopathic dilated cardiomyopathy. Am. J. Cardiol. 1991; 68:1372–1376.CrossRefGoogle ScholarPubMed
Bridges, N. D., Mallory, G. B. Jr, Huddleston, C. B.et al.Lung transplantation in children and young adults with cardiovascular disease. Ann. Thorac. Surg. 1995; 59:813.CrossRefGoogle Scholar
Kerem, E., Reisman, J., Corey, M.et al.Prediction of mortality in patients with cystic fibrosis. N. Engl. J. Med. 1992; 326:1187.CrossRefGoogle Scholar
Shaddy, R. E., Bullock, E. A., Morwessel, N. J.et al.Murine monoclonal CD3 antibody (OKT3)-based early rejection prophylaxis in pediatric heart transplantation. J. Heart and Lung Transpl. 1993; 12:434–439.Google ScholarPubMed
del Nido, P. J., Armitage, J. M., Fricker, F. J.et al.Extracorporeal membrane oxygenation support as a bridge to pediatric heart transplantation. Circulation 1994; 90(2):11–66.Google ScholarPubMed
Kirshborn, P. M., Bridges, N. D., Myung, R. J.et al.Use of extracorporeal membrane oxygenation in pediatric thoracic organ transplantation. J. Thorac. Cardiovasc. Surg. 2002; 123(1):130–136.CrossRefGoogle Scholar
Fortuna, K. S., Chinnock, R. E., Bailey, L. L.et al.Heart transplantation among 233 infants during the first six months of life: the Loma Linda experience. Clin. Transpl. 1999:263–272.Google ScholarPubMed
Tamisier, D., Vouhe, P., Bidois, J.et al.Donor–recipient size matching in pediatric heart transplantation; a word of caution about small grafts. J. Heart Lung Transpl. 1996; 15:190–195.Google ScholarPubMed
West, L. J., Pollock-Barziv, S. M., Dipchand, A. I.et al.ABO-incompatible heart transplantation in infants. N. Engl. J. Med. 2001; 344(11):793.CrossRefGoogle Scholar
Canter, C. E., Soffitz, J. E., Moorehead, S.et al.Early results after pediatric cardiac transplantation with triple immunosuppression therapy. Am. J. Cardiol. 1993; 71:971.CrossRefGoogle ScholarPubMed
Canter, C. E., Moorehead, S., Soffitz, J. E.et al. Steroid withdrawal in the pediatric heart transplant recipient initially treated with triple immunosuppression. J. Heart Lung Transpl. 1994; 13:74.Google ScholarPubMed
Swenson, J. M., Fricker, F. J., & Armitage, J. M.Immunosuppression switch in pediatric heart transplant recipients: cyclosporine to FK506. J. Am. Coll. Cardiol. 1995; 25(5):1183.CrossRefGoogle Scholar
Kobashigawa, J. A.Mycophenolate mofetil in cardiac transplantation. Curr. Opin. Cardiol. 1998; 13(2):117–121.CrossRefGoogle ScholarPubMed
Braunlin, E. A., Canter, C. E., Olivari, M. T.et al.Rejection and infection after pediatric cardiac transplantation. Ann. Thorac. Surg. 1990; 49:385.CrossRefGoogle ScholarPubMed
Canter, C. E., Appleton, R. S., Soffitz, J. E.et al.Surveillance for rejection by echocardiographically guided endomyocardial biopsy in the infant heart transplant recipient. Circulation 1991; 84(Suppl III) 111–310.Google ScholarPubMed
Bailey, L. L., Gundry, S. R., Razzouk, A. J.et al.Bless the babies: one hundred fifiteen late survivors of heart transplantation in the first year of life. J. Thorac. Cardiovasc. Surg. 1993; 105:805.Google ScholarPubMed
Pahl, E., Zalos, V. R., Ficker, F. I.et al.Posttransplant coronary artery disease in children: a multicenter national survey. Circulation 1994; 9(2):11–56.Google Scholar
Braulin, E. A., Hunter, D. W., Canter, C. E.et al.Coronary artery disease in pediatric cardiac transplant recipients receiving triple-drug immunosuppression. Circulation 1991; 84(Suppl III):111–303.Google Scholar
Michler, R. E., Edward, N. M., Hsu, D.et al.Pediatric retransplantation, J. Heart Lung Transpl. 1993; 12:5319.Google ScholarPubMed
Seipelt, I. M., Crawford, S. E., Rodgers, S.et al.Hypercholesterolemia is common after pediatric heart transplantation: initial experience with pravastatin. J. Heart Lung Transpl. 2004; 23(3):317–322.CrossRefGoogle ScholarPubMed
Spray, T. L.Transplantation of the heart and lungs in children. Am. Rev. Med. 1994; 45:139–148.CrossRefGoogle ScholarPubMed
Razzouk, A. J., Chinnock, R. E., Gundry, S. R.et al.Transplantation as primary treatment for hypoplastic left heart syndrome: intermediate-term results. Ann. Thorac. Surg. 1996; 62:1–8.CrossRefGoogle ScholarPubMed
Shaddy, R. E., Naftel, D. C., Kirklin, J. K.et al.Outcome of cardiac transplantation in children: survival in a contemporary multi-institutional experience. Circulation 1996; 94(Suppl):II69–II73.Google Scholar
Backer, C. L., Zales, V. R., Harrison, H. L.et al.Intermediate term results of infant orthotopic cardiac transplantation from two centers. J. Thorac. Cardiovasc. Surg. 1991; 101:826–832.Google ScholarPubMed
Zales, V. R., Wright, K. L., Pahl, E.et al.Normal left ventricular muscle mass and mass/volume ratio after pediatric cardiac transplantation. Circulation 1994; 90(2):11–61.Google ScholarPubMed
Nixon, P. A., Fricker, F. J., Noyes, B. E.et al.Exercise testing in pediatric heart, heart–lung and lung recipients. Chest 1995; 107:1328.CrossRefGoogle Scholar
Cooper, J. D. 1996 Report of the St Louis International Lung Transplant Registry.
Huddleston, C. B., Bloch, J. B., Sweet, S. C.et al.Lung transplantation in children. Ann. Surg. 2002; 236(3):270–276.CrossRefGoogle ScholarPubMed
Bridges, N. D., Mallory, G. B. Jr, Huddleston, C. B.et al.Lung transplantation in infancy and early childhood. J. Heart Lung Transpl. 1996; 15:895–902.Google ScholarPubMed
Koutlas, T. C., Bridges, N. D., Gaynor, J. W.et al.Pediatric lung transplantation: are there surgical contraindications?Transplantation 1997; 63:269–274.CrossRefGoogle ScholarPubMed
Starnes, V. A., Barr, N. L., & Cohen, R. G.Lobar transplantation. J. Thorac. Cardiovasc. Surg. 1994; 108:403–411.Google ScholarPubMed
Starnes, V. A., Bowdish, M. E., Woo, M. S.et al.A decade of living lobar lung transplantation: recipient outcomes. J. Thorac. Cardiovasc. Surg. 2004; 127:115–122.CrossRefGoogle ScholarPubMed
Conte, J. V., Robbins, R. C., Reishenspurner, H.et al.Pediatric heart–lung transplantation: intermediate-term results. J. Heart Lung Transpl. 1996; 15:692–699.Google ScholarPubMed
Madden, B., Radley-Smith, R., Hodson, M.et al.Medium term results of heart and lung transplantation. J. Heart Lung Transpl. 1992; 11:S241–S243.Google ScholarPubMed
Whitehead, B. F., Rees, P. G., Sorensen, K.et al.Results of heart–lung transplantation in children with cystic fibrosis. Eur. J. Cardiothorac. Surg. 1995; 9:1–6.CrossRefGoogle ScholarPubMed
Baum, M., Chinnock, R., Ashwal, S.et al.Growth and neurodevelopmental outcome of infants undergoing heart transplantation. J. Heart Lung Transpl. 1993; 12:S211–S217.Google ScholarPubMed
Bernstein, D., Kolla, S., Miner, M.et al.Cardiac growth in pediatric heart transplantation. Circulation 1992; 85:1433–1439.CrossRefGoogle ScholarPubMed
Hirsch, R., Huddleston, C. V., Mednedloff, E. N.et al.Infant and donor organ growth after heart transplantation in neonates with hypoplastic left heart syndrome. J. Heart Lung Transpl. 1996; 15:1093–1100.Google ScholarPubMed
Sweet, S. C.Pediatric lung transplantation: update 2003. Pediatr. Clin. N. Am. 2003; 50:1393–1417.CrossRefGoogle ScholarPubMed
Nixon, P. A., Fricker, F. J., Noyes, B. E.et al.Exercise testing in pediatric heart, heart–lung and lung recipients. Chest 1995; 107:1328.CrossRefGoogle Scholar

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