Resultados de un programa nacional de trasplante cardiaco pediátrico: fortalezas y debilidades

Abstract

Introduction: Pediatric heart transplantation is an effective therapy to treat advanced heart failure in children. Objectives: To analyze the immediate and mid-term results of pediatric patients listed for heart transplantation. Material and Methods: Registration of patients admitted to our transplant protocol between October 2001 and July 2016 were reviewed, analyzing demographic data, diagnosis, status at the time of listing, waiting time until transplantation, donor data, use of ventricular assist device, hemodynamic data, complications and global mortality. Results: Thirthy patients where included with a mean age of 9.4 years (1 month to 15 years). The most frequent diagnosis was dilated cardiomyopathy in 24 patients (80%). The status was I (urgency) in 19 cases and II in 11 cases. Ten patients died on the waiting list (33,3%) at an average of 52 days (13-139 days). Fourteen were transplanted (46.7%), with a waiting time of 199.6 days (4-586 days). Nine patients required mechanical support (30%). All patients received triple association of immunosuppression. One patient died 16 days post transplant due to primary graft failure (7.1%). The average follow-up was 43 months (0.5-159 months). Two patients died later on (82 and 55 months), both due to secondary rejection because of voluntary cessation of immunosuppressive therapy. Survival at 1 and 5 years was 93% and 74%, respectively. Conclusions: Our program has successfully transplanted 50% of patients enrolled, with good medium-term survival. A significant proportion of patients were listed urgently and 34.5% died on the waiting list.

Miocardiopatía no compactada y restrictiva en pediatría: dos tipos de enfermedades del miocardio que son importantes saber reconocer

“…El 4-14% de los pacientes con MCNC llegan finalmente a ser trasplantados, con tasas de éxito de hasta un 77% y mortalidad en lista de espera de un 7,9% en centros con alto volumen de trasplante 19,27,28 . En nuestro país Becker 29 publicó su serie de trasplante cardiaco, donde el 96,6% correspondían a niños con MCP, fallecieron en lista de espera el 33,3%. No hay series nacionales específicas en MCNC.…”

Miocardiopatía dilatada en el niño

“…La incidencia de MCD es de 0.57 casos por cada 100.000 niños, siendo mayor en hombres que en mujeres (0,66 vs 0,47 casos por 100.000), en raza negra (0.98 vs 0.46 casos por 100.000), y en lactantes en comparación con mayores de 1 año (4,4 vs 0,34 casos por 100.000) 3,10 . En Chile no existen estudios poblacionales de MC pediátricas; sin embargo, de acuerdo a la experiencia reportada de TC en niños, el diagnóstico predominante fue la MCD 11 .…”