Pediatric heart transplantation: 23

a gery, ardio r 2010 durin influ our r and t European Journal of Cardio-thoracic Suincluded 169 pediatric HTx recipients, transplanted between 05/1986 and 05/2010. One hundred and one were males with a median age of 8.7 (0.02—23.2) years at the time of HTx. Main preoperative diagnoses were cardiomyopathy (CMP) (n = 139) with a median survival of 7.0 (0—23.2) years and congenital heart disease (CHD) (n = 30), median survival 11.3 (0—19.9) years. Overall survival at 1, 5, 10, and 15 years was 87%, 76%, 68%, and 50%, respectively. Patient survival was significantly reduced in patients with 0—1 year at the time of HTx versus 1— 10 and 11—18 years: 2.3 (0—13.2) years versus 1—10 years = 8.6 (0—23.2) years; 11—18 years = 5.9 (0.003—18.5) years. Fifty-one patients were on mechanical circulatory support as a bridge-to-HTx with increased early but not late mortality. Ten patients underwent retransplant due to acute or chronic graft failure after a median posttransplant time of 12.25 (0.3—17.45) years. Late mortality was influenced by rejection, infection, posttransplant lymphoproliferative disease (PTLD) (11.8%), or CAV with an incidence of 25 % at 5 years, 50 % at 10 years, and approximately 75 % at 15 years. Conclusions: Pediatric HTx is a safe and effective treatment for terminal heart failure. In our experience, there is no adverse effect of previous cardiac assist device implantation in long-term follow-up. Virtually all anatomic malformations are amenable to orthotopic HTx. Significant progress has been achieved in controlling rejection through improved immunosuppression and noninvasive rejection monitoring