Experience of pediatric heart transplantation in Hong Kong

Abstract

OBJECTIVE: To describe the outcome and complications of the first three pediatric heart transplant patients in Hong Kong. METHOD: Three patients aged 6, 14, and 15 years who had undergone heart transplantation in 2009 were retrospectively reviewed. RESULTS: All patients suffered from end-staged heart failure related to idiopathic-dilated cardiomyopathy. Two patients (aged 6 and 15 years) are currently alive and are in NYHA class I. One patient had low cardiac output and intrathoracic bleeding on Day 1 after transplant requiring re-exploration and haemostasis. He developed complications of fungal septicemia, pancytopenia, necrotizing pancreatitis with pseudocyst formation, abdominal sepsis, tacrolimus-induced encephalopathy, and renal failure. He died of multi-organ failure 2 months after transplantation. The 6-year-old patient developed confusion and seizure on Day 10 after transplant. Magnetic resonance imaging brain showed features compatible with posterior reversible encephalopathy syndrome (PRES) due to cyclosporine neurotoxicity. She made a complete recovery without any neurological sequelae after stopping of cyclosporine. Both surviving patients had one episode of grade 2R acute cellular rejection treated with oral pulsed steroid. The patient who died had grade 1R acute cellular rejection. The immunosuppressant therapy consists of cyclosporine or tacrolimus, mycophenolate mofetil, and prednisolone. CONCLUSION: Heart transplantation is an option of treatment for end-staged heart failure in children. Achievement of successful outcome is possible in Hong Kong. We encountered uncommon complications of PRES and necrotizing pancreatitis in our patients.