Dados do Trabalho

Título

HEART RE-TRANSPLANTATION FOR CORONARY ALLOGRAFT VASCULOPATHY IN CHILDREN: 25 YEARS OF SINGLE-CENTRE EXPERIENCE

Introdução

Paediatric end-stage heart disease is surgically managed by heart transplantation. A major complication of primary transplantation (PTx) is coronary allograft vasculopathy (CAV), a form of accelerated atherosclerosis. Re-transplantation (RTx) has been the management of CAV, however there is limited comprehensive literature on this subject. Here we report 25 years of single-centre experience in managing CAV with RTx and place it in the context of recent studies.

Material e Método

A retrospective cohort study was undertaken on patients who underwent PTx <18 years old and subsequent RTx due to CAV at the Heart Institute (InCor) University of São Paulo Medical School between 1992 and 2018. The maintenance immunosuppression protocol was double immunosuppression. For both PTx and RTx, quantitative and qualitative analyses were conducted for: transplantation indication, donor / recipient demographics, post-transplant survival, rejection, infection, and immunosuppression.

Resultados

Between 1992 and 2018, 200 children underwent heart transplantation. Ten re-transplantations were performed, for which seven (70%) were for CAV. Ages at RTx ranged from 11.5 to 29.3 years (19.1 ± 5.68 years; median 18.2 years). The mean time between PTx and RTx was 12.9 ± 3.4 years (median 13.4 years). Kaplan Meier survival rate was at one month, 3 years and 5 years was 85.7%, 71.5% and 47.6% respectively.

Discussão e Conclusões

Cardiac RTx can be a management option for CAV in patients who have undergone PTx in childhood with double immunosuppression therapy.

Palavras Chave

heart re-transplantation ; children; survival

Área

CORAÇÃO/PULMÃO