Clinical Outcome of Heart Transplantation in Children and Young Adults with Congenital and Acquired Heart Disease in a Middle-Income Country: A 20-Year Experience from a Single Center in Brazil

ABSTRACT

Introduction:  Orthotopic heart transplantation (OHT) has become the standard of care for children with end-stage heart failure refractory to medical or surgical therapy. Despite the improvement in perioperative survival in the last decades, the long-term complications and mortality remain significant. This report examines the experience of a single center in Brazil with pediatric OHT, focusing on long-term results and mortality.

Methods:  This is a retrospective study from January 2002 to December 2022. Data collection consisted of demographic data, indication for heart transplantation, immunosuppression, main complications, and mortality.

Results:  There were 77 OHT in 74 patients. The median age at the time of OHT was 11.5 years (interquartile range 0.25 - 22 years). The indications for OHT were congenital heart disease in 46.8%, cardiomyopathy in 45.5%, and retransplantation in 3.9% of the patients. There was an average of 2.2 rejection episodes/patient and 1.3 infection episodes/patient during the first year of follow-up. The most common long-term complications were acute kidney injury (51%), systemic arterial hypertension (40.5%), and post-transplantation diabetes mellitus (10.4%). Overall survival after one year of OHT was 89.6% and fiveand 10-year survivals were 80% and 59%, respectively.

Conclusion:  Heart transplant is an acceptable therapeutic option for children and young adults in middle-upper income countries, with outcomes and long-term follow-up close to those of high-resource countries.

Keywords:
Heart Transplantation; Pediatric; Heart Failure; Congenital Heart Disease; Cardiomyopathy.