# Clinical Outcome of Heart Transplantation in Children and Young Adults with Congenital and Acquired Heart Disease in a Middle-Income Country: A 20-Year Experience from a Single Center in Brazil

## TL;DR

This study examines heart transplant outcomes in children and young adults in Brazil over 20 years, showing survival rates comparable to high-income countries.

## Contribution

The study provides long-term clinical outcomes of pediatric heart transplantation in a middle-income country setting.

## Key findings

- Overall one-year survival after heart transplant was 89.6%.
- Common long-term complications included acute kidney injury and hypertension.
- Five- and ten-year survival rates were 80% and 59%, respectively.

## Abstract

Orthotopic heart transplantation (OHT) has become the standard of care for
children with end-stage heart failure refractory to medical or surgical
therapy. Despite the improvement in perioperative survival in the last
decades, the long-term complications and mortality remain significant. This
report examines the experience of a single center in Brazil with pediatric
OHT, focusing on long-term results and mortality.

This is a retrospective study from January 2002 to December 2022. Data
collection consisted of demographic data, indication for heart
transplantation, immunosuppression, main complications, and mortality.

There were 77 OHT in 74 patients. The median age at the time of OHT was 11.5
years (interquartile range 0.25 - 22 years). The indications for OHT were
congenital heart disease in 46.8%, cardiomyopathy in 45.5%, and
retransplantation in 3.9% of the patients. There was an average of 2.2
rejection episodes/patient and 1.3 infection episodes/patient during the
first year of follow-up. The most common long-term complications were acute
kidney injury (51%), systemic arterial hypertension (40.5%), and
post-transplantation diabetes mellitus (10.4%). Overall survival after one
year of OHT was 89.6% and fiveand 10-year survivals were 80% and 59%,
respectively.

Heart transplant is an acceptable therapeutic option for children and young
adults in middle-upper income countries, with outcomes and long-term
follow-up close to those of high-resource countries.