Heart transplantation in young children and infants may be controversial. The aim of this study was to review long-term follow-up of heart transplanted small children and assess prognosis and outcomes.

Material and methods .– Patients who underwent orthotopic heart transplantation (OHT) within the first 3 years of life were included in the study. Demographics, clinical data, events, outcomes and survival were assessed.

Results .– Among 96 paediatric heart transplantations performed in a French single-centre, 25 patients who underwent OHT at ≤ 3 years of age, were included in the study (10 males, 15 females). Among them, 10 (40%) were on VAD support at the time of OHT. Age at OHT was 1.5 ± 0.9 years (median 1.2). Underlying cardiac disease was congenital in four (16%) or idiopathic cardiomyopathy in 21 (84%). Post-transplant follow-up was 7.1 ± 7 years (range 1day to 22.7) and was > 10 years in seven cases (28%). Three patients died at first day, second year and fourth year post-transplant. Mean age of survivors at the time of the study was 9.1 ± 7.3 years (range 1.5 to 23.6). One acute rejection episode occurred at first month post-transplant and one at 11th year. One patient had post-transplant lympho-proliferative disease at 14th year post-transplant and was successfully cured. Graft coronary disease occurred in two cases (8%), who underwent second heart and kidney transplantation at 16th and 22nd year after first transplant. All other cases were free from coronary disease with normal graft function. End-stage renal failure occurred in the two re-transplanted cases. Significant severe renal dysfunction was present in three cases (no dialysis), moderate in three cases, and 17 had normal renal function. Linear growth ranged within normal in all patients, except the two cases with end-stage renal failure, despite continuous low dose steroid therapy in 80% of the survivors. All patients are in NYHA class I, except the two re-transplanted cases who were in NYHA class IV at the time of second transplant. Patient survival was 96% at 1-year, 90.7% at 3-year and 83% at 10-year post-transplant follow-up. Graft survival was respectively 96%, 90.7%, 83% and 66% at 1-, 3-, 10- and 16-year follow-up.

Conclusion .– Long-term survival of very young heart transplant recipient is fairly good, with a low incidence of graft coronary disease and optimal functional status and growth.