Determine retrospectively the factors affecting mortality and morbidity in pediatri̇c age cardiac transplant recipients

Aim : Heart failure is important cause of mortality and morbidity not only for adults, but also for pediatric age group. In the guideline published in 2013 by The American College of Cardiology Foundation(ACCF) and the American Heart Association(AHA), heart failure is described as a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. The most common causes of the heart failure are congenital heart disease and cardiomyopathies. In addition, many causes such as myocarditis, intoxications, arrhythmias, intracardiac tumors, systemic diseases can cause heart failure. The main purpose of the heart failure treatment is prevent progression of disease and to keep the patients listed in the heart transplantation list stable. Medical treatment, mechanical support and cardiac tranplantation are used for this purpose. Although cardiac tranplantation is last option for terminal stage heart failure in the past, nowadays this is accepted as the gold standart treatment for severe heart failure unresponsive to treatment. In this study, we aimed to investigate the recipient and donor releated factors which influence mortality and morbidity and long term outcomes in our pediatric heart transplantation patients. Material and Methods: Twenty-two patients undergoing cardiac transplantation between October 2007 and June 2019 followed by Ege University Pediatric Cardiology Department were included in the study. All data of the patients were evaluated retrospectively using file scanning method. Results: Of 22 patients included, 6(27.3%) were female and 16(72.7%) were male. The median transplantation age was 13.1(min 5.6-max 17) years. When the etiology of heart failure investigated, dilated cardiomyopathy was assessed as the most common cause (n = 17; 77%). Restrictive Cardiomyopathy (RCMP) (n = 2; 9%), Arrhythmogenic Right Ventricular Dysplasia (n = 2; 9%) and Hypertrophic Cardiomyopathy (n = 1; 5%) are other causes of heart failure. Median waiting time in the transplant list was 9.5(min 0.6–max 38) months. During the waiting period, 14(63.6%) patients were bridged to cardiac transplantation with mechanical support devices. After cardiac transplantation, 12(54.5%) patients had 18 infection attacks requiring hospitalizations, 14(63.6%) patients had a total of 23 rejection attacks, 10(45.5%) patients had drug side effects and 5(23%) patients had arrhythmias. There was no valve dysfunction requiring valve repair or replacement. Four of 22 patients(18.2%) died in the first 6 months after transplantation. The 1-year, 5-year and 10-year survival rates were 81.8%, 81.8% and 81.8%; The mean survival time was calculated 9.85 ± 0.97 years. No patient died due to infection, rejection, arrhythmia and drug side effects. Whereupon cardiac transplantation, 4 patients supported with intra-aortic balloon pump due to early graft dysfunction. In one of these 4 patients, heart failure symptoms regressed; The other 3 patients were supported by extracorporeal membrane oxygenation due to ongoing heart failure symptoms and all 3 patients died. There was a statistically significant relationship between IABP and ECMO requirement after transplantation and mortality (p = 0.013 and p = 0.003). Conclusion: The survival rate in pediatric patients undergoing cardiac transplantation was 81.8%. There was no complication causing mortality other than EGD. Only one of the rejection attacks was severe rejection. There were no serious rejection attacks that were resistant to immunosuppressive therapy or caused heart failure. The most important limitation of heart transplantation is the insufficient number of donors. In our center, 162 patients died while waiting on the list of cardiac transplantation between 2015-2019 and 15 of them were children. During the same period 5 pediatric patients underwent cardiac transplantation and all 5 survived. This is shown that 1(25%) of 4 children waiting for cardiac transplantation were transplanted and 3(75%) were died. Cardiac transplantation is the gold standard treatment that increasing of life quality and survival in patients with end-stage heart failure. Keywords: Heart failure; pediatric cardiac transplantation; mortality; morbidity