ObjectiveTo provide a practical reference for optimizing pediatric heart transplantation protocols in China by summarizing the perioperative management and short-term outcomes of pediatric heart transplant recipients at our center. MethodsWe retrospectively analyzed the medical records of all pediatric heart transplant patients performed at the Heart Center of the Children's Hospital, Zhejiang University School of Medicine, between June 2023 and September 2025. Data on donor and recipient demographics, indications for transplantation, use of mechanical circulatory support (MCS) as a bridge to transplant, perioperative clinical parameters, postoperative complications, immunosuppressive regimens, and follow-up outcomes were collected and analyzed. ResultsA total of 12 pediatric patients were enrolled, including 5 females and 7 males, with a median age of 9.7 (7.0, 13.0) years, all diagnosed with cardiomyopathy. MCS was used as a bridge to transplant in 58.33% of patients, including extracorporeal membrane oxygenation in 41.67% and a left ventricular assist device in 16.67%. The median donor heart cold ischemic time was 355 (306, 376) minutes. The most common postoperative complications were acute kidney injury (58.3%) and infection (58.3%). One week postoperatively, the median left ventricular ejection fraction recovered to 67.2% (61.8%, 71.0%). At discharge, 10 patients were in New York Heart Association (NYHA) functional class Ⅰ and 2 patients were in class Ⅱ. Over a follow-up period of 1 to 27 months, all patients survived with good cardiac function. ConclusionOur single-center experience demonstrates satisfactory short-term survival and cardiac function recovery in pediatric heart transplantation. Key areas requiring optimization include strategies for MCS bridging, management of prolonged donor heart cold ischemic time, and individualization of immunosuppressive regimens. Future development of a multi-center registry and genomics-guided precise immunosuppression strategies holds the potential to further improve long-term outcomes.
ObjectiveTo analyze the short- and long-term therapeutic effects of heart transplantation in children. MethodsA retrospective study was conducted on recipients and donors who underwent heart transplantation at the 7th People’s Hospital of Zhengzhou from May 2018 to August 2023, analyzing their clinical characteristics, surgical data, postoperative complications, and survival rates. ResultsA total of 22 children underwent heart transplantation, including 14 males and 8 females, with a median age of 13.5 (10.0, 15.0) years and a median weight of 41.9 (30.5, 55.4) kg. The primary diseases included: dilated cardiomyopathy in 16 patients, hypertrophic cardiomyopathy in 1 patient, myocardial dysplasia in 3 patients, right ventricular dysplasia in 1 patient, and congenital heart disease with abnormal coronary artery origin in 1 patient. The median age of the donors was 21.0 (13.0, 29.0) years, and the median weight was 50.5 (47.3, 75.0) kg. The blood types of the donors and recipients were the same, with type A in 10 patients, type B in 5 patients, type O in 5 patients, and type AB in 2 patients. Before transplantation, all children had a New York Heart Association cardiac function grade Ⅳ, with 1 patient assisted by intra-aortic balloon pump (IABP), 3 patients assisted by extracorporeal membrane oxygenation (ECMO), 2 patients assisted by continuous renal replacement therapy (CRRT), and 2 patients on mechanical ventilation. Nine patients met the criteria for emergency child status allocation, and the panel reactive antibody level in the patients was<10%. The median cold ischemic time of the donor heart was 355.0 (262.0, 395.5) min, the median aortic cross-clamping time was 45.0 (38.3, 51.3) min, the median mechanical ventilation time was 22.5 (16.8, 52.5) h, the median postoperative hospital stay was 29.5 (20.0, 43.0) d, and the median intensive care unit stay was 6.0 (5.0, 8.3) d. After surgery, 4 patients were assisted by ECMO, 2 patients by CRRT, and 7 patients developed complications, including lung fungal infection in 6 patients, liver and kidney dysfunction in 1 patient, local wound non-union and mediastinal infection in 1 patient, and multiple organ failure in 1 patient. Kaplan-Meier curve analysis showed that the survival rates of children after surgery were 91.3% at 1 year and 3 years; the survival rates of adult heart transplant recipients at our center were 86.7% and 73.8% at 1 year and 3 years, respectively, indicating that the survival rate of children with heart transplantation was higher than that of adult patients. ConclusionHeart transplantation is an effective treatment for end-stage heart failure in children, and the short- and long-term survival rates of children with heart transplantation are superior to those of adults. There are still many difficulties to be solved in pediatric heart transplantation, requiring joint efforts from society and the medical community.
ObjectiveTo analyze the risk factors for pediatric heart transplantation at a single center and its impact on short-term prognosis, providing experience and reference for pediatric heart transplantation. MethodsThe children who underwent heart transplantation from May 2022 to May 2024 at the Seventh Medical Center of Chinese PLA General Hospital were included in this study. We conducted a retrospective analysis of the clinical data of donors and recipients, perioperative conditions, and postoperative complications. The double-lumen venoplasty technique was used for all surgeries. Basiliximab was applied for immune induction during and after the operation (on the 4th day). Tacrolimus+mycophenolate mofetil+prednisolone acetate was used for postoperative immunosuppressive maintenance treatment. According to whether patients had a history of extracorporeal membrane oxygenation (ECMO) installation before surgery, they were divided into an ECMO group and a non-ECMO group. The postoperative ICU stay time, postoperative ventilator assistance time, aortic clamping time, cardiopulmonary bypass time, recipient body surface area, left ventricular ejection fraction, X-ray cardiothoracic ratio, donor heart cold ischemia time, and the weight ratio between donor and recipient were compared between the two groups, and correlation analysis was performed. ResultsA total of 17 children were included, with 10 (58.8%) males and 7 (41.2%) females. Their ages ranged from 7 months to 16 years, with a median age of 11.0 (10.0, 13.0) years. Their weights ranged from 7.0 to 67.5 kg, with an average weight of (41.6±16.7) kg. Of the 17 children, 16 survived post-operation, and 1 died 5 days after the operation. Five patients were ABO incompatible heart transplantations, and 11 patients had a history of ECMO installation before surgery. The left ventricular ejection fraction of the non-ECMO group was higher than that of the ECMO group (t=2.188, P=0.045). The postoperative ICU stay time and postoperative ventilator assistance time (r=0.599, P=0.011), and cardiopulmonary bypass time (r=0.667, P=0.003) were positively correlated. The cardiothoracic ratio was negatively correlated with the postoperative ventilator assistance time (r=?0.527, P=0.030). ConclusionPediatric heart transplantation is an effective treatment method for children with end-stage heart failure. The left ventricular ejection fraction of the recipient may be a predictive factor indicating that the child needs ECMO assistance. Longer extracorporeal circulation time and larger recipient body surface area may affect the surgical process and perioperative prognosis.
