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September 1992

Neonatal Cardiac TransplantationIntermediate-Term Results and Incidence of Rejection

Author Affiliations

From the Division of Cardiothoracic Surgery, Department of Surgery, Loma Linda (Calif) International Heart Institute (Drs Chiavarelli, Gundry, Razzouk, and Bailey), the Division of Pediatric Cardiology, Department of Pediatrics, Loma Linda International Heart Institute (Dr Boucek), and the LLUMC Immunology Center (Dr Nehlsen-Cannarella), Loma Linda University School of Medicine, Loma Linda University Medical Center.

Arch Surg. 1992;127(9):1072-1076. doi:10.1001/archsurg.1992.01420090080011

• Early age at cardiac transplantation may favor successful engrafting with minimal chronic immunosuppression. Fifty-two newborns underwent orthotopic heart transplantation; 47 (90%) survived the operation, and 44 (85%) were late survivors. Actuarial survival was 92% at 1 month, 86% at 1 year, and 84% at 5 years. Forty-four infants who survived 12 weeks and the corresponding 100 rejection episodes were analyzed. Mean follow-up was 2.2 years. The mean number of rejections per year of follow-up was 1.2. No episodes of rejection were identified in six patients. Seven patients had a late rejection episode more than 1 year after transplantation, and only one had a late rejection episode after 2 years. Neonatal cardiac transplantation is effective and durable therapy for uncorrectable heart disease. Intermediate-term results are excellent. Severe rejection is uncommon, and few episodes occur after 1 year of follow-up.

(Arch Surg. 1992;127:1072-1076)