In June 1984, the first successful orthotopic heart transplant (OHT) performed in a child occurred at Columbia University Medical Center (CUMC) for congenital heart disease (CHD). OHT has since become the accepted therapy for end-stage heart failure due to cardiomyopathy (CM), CHD, and other cardiac disease in pediatrics. We report our 35-year experience at a high-volume pediatric OHT center.
An institutional retrospective chart review of patients (pts) who underwent OHT at CUMC from 1984-2019 was performed. Kaplan-Meier analysis was implemented for pt and graft survival and stratified by era. Development of post-OHT morbidities (re-OHT, oncologic disease, end-stage renal disease [ESRD]) were examined.
Over 35 years (yrs), 577 OHT were performed in 539 pts. Median age at OHT was 9.06 yrs (IQR 2.00, 14.66); 296 (54.9%) were male. Indication for primary OHT was cardiomyopathy in 334 pts (62.0%), CHD in 199 pts (36.9%), and other in 6 pts (1.1%). There were 38 re-OHT in 34 pts (6.3%). Overall pt survival at 5, 10, 20 yrs was 79.4%, 67.7%, 52.0%, with median survival of 21.1 yrs (95% CI 17.2 - 26.5). Eleven pts survived >30 yrs after OHT. For pts transplanted in the most recent era (2008 - 2019), survival at 5, 10 yrs was 87.0%, 79.5%, improved from prior eras (p<0.001, figure). Of 339 pts who underwent primary OHT before 2010, 210 (61.9%) survived >10 yrs, 76.9% of whom survived >20 yrs. Forty-five pts (8.3%) developed tumors within 10 yrs of OHT. Of 168 pts with 10 yr tumor-free survival, 25 (14.9%) developed tumors at a median time of 12.9 yrs post-OHT. Of pts with 10 yr ESRD-free survival, 11.7% developed ESRD at a median time of 15.1 yrs post-OHT.
Long-term survival continues to improve in pediatric OHT. However, serious morbidities remain including need for retransplant and the ongoing potential for development of renal and oncologic disease. As novel immunosuppression protocols emerge, improvements in long-term outcomes will accompany a decreasing risk of associated major morbidities.
© 2021 Published by Elsevier Inc.