Survival Rates and Risks
Life expectancy following pediatric heart transplantation is not known. Since the procedure has only been done since the mid 80’s, no information is available on what will occur during longer follow-up.
Survival Rates at Children's Hospital
From 1987 to 2012, survival rates following pediatric heart transplantation at Monroe Carell Jr. Children’s Hospital at Vanderbilt are:
- 95 percent at one month
- 90 percent at one year
- 78 percent at five years
- 73 percent at 10 years
Between January 2000 and December 2012, survival in children undergoing heart transplant at Children’s Hospital has improved to 99 percent at one month, and 93 percent at one year.
Overall Survival Rates
Our results compare very favorably with overall survival rates reported by the Registry of the International Society for Heart and Lung Transplantation Report (Journal of Heart and Lung Transplantation; Volume 31, Issue 10, Oct. 2012, pages 1045-1095).
- 90 percent at one month
- 82 percent at one year
- 70 percent at five years
- 59 percent at 10 years
Heart transplantation is not a cure, and late complications can occur. After transplantation, a child can develop an infection or rejection at any time; however, both become less likely after the first year. Children on chronic immunosuppressive medications are also at increased risk for developing cancer, especially a particular cancer of the blood stream called lymphoma. According to the ISHLT data, the risk of lymphoma in pediatric heart transplant patients is approximately eight percent at 10 years.
Another major concern is the development of narrowing of the coronary arteries after heart transplantation. These are the vessels that transport blood to the heart muscle itself. The changes are similar to those seen in older adults that can lead to heart attacks, though the cause is different. Some children die from this problem, while others have had a second heart transplant surgery. Another transplant is usually the only treatment if the narrowing becomes severe.
According to the ISHLT data, the risk of coronary artery disease in children is approximately 15 percent at five years. Our experience is that those transplanted at younger ages, less than 10 years and those done in 1997 or later, have significantly less risk of coronary artery disease. Other potential complications of the immunosuppressive medications include high blood pressure and kidney dysfunction. On rare occasions, these children may also require a kidney transplant. Many people are working to discover better ways to manage these long-term complications of transplantation. In fact, there has been a significant decrease in the incidence of many of these complications in recent years, probably due to the use of newer immunosuppressive medicines.
A transplanted heart is living tissue that grows normally with your child. Because we use a steroid-free immunosuppressive regimen, the growth of our patients is in the normal range. Most children have no activity limits, attend regular school, and participate in some competitive sports. Hospital readmission is uncommon outside the immediate post-operative period.
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