Heart transplantation in childhood
A new heart
In 1967, the first heart transplant was successfully performed in South Africa by heart surgeon Christiaan Barnard on an adult patient; this treatment was first made possible for children in the USA in 1984. Heart transplants in children and adolescents have also been successfully performed at the Medical University of Vienna since 1985 and 2-10 children are transplanted each year (1985-2023: 95 children and adolescents).
A heart transplant in children and adolescents is always necessary if the child's own heart can no longer be adequately treated with medication or surgery due to congenital heart muscle weakness (cardiomyopathy), a congenital heart defect (vitium cordis) or after an inflammation of the heart muscle (myocarditis).
In this case, children can be registered for a heart transplant and placed on a high urgency (HU) waiting list at Eurotransplant, the European distribution center. The waiting time for a donor heart varies greatly. If the child's condition continues to deteriorate during this time, an artificial heart (assist device) may be necessary to bridge the gap in order to keep the cardiovascular system stable.
If a suitable organ is offered, the child is prepared for the organ transplant.
A well-planned procedure to get the donor heart to the recipient as quickly as possible is key to the success of a heart transplant. In children with congenital heart defects, the transplantation can be very complex surgically, but otherwise follows a standardized procedure. As after every heart operation, the children are then cared for in the pediatric intensive care unit and then in the pediatric cardiology IMC ward until they are discharged home.
After the heart transplant, a lifelong intake of medication (immunosuppressants) is necessary to protect against rejection of the new heart.This consists of a combination of different substances that slow down the immune system and whose effectiveness is checked in regular laboratory tests.
The immunosuppressive medication increases the risk of infection, so special precautions and rules of conduct must be observed in everyday life. There are also special aspects to consider when selecting and preparing food, which families and patients are well trained in before discharge.
Regular follow-up examinations are carried out by the treating pediatric cardiologist and in a special pediatric cardiology outpatient clinic at the Children's Heart Center Vienna.
In addition to standard examinations such as echocardiography, ECG and laboratory tests, extended radiological examinations such as MRI and CT scans are occasionally ordered.
Non-invasive methods are increasingly being used to monitor rejection reactions, but taking samples from the heart (myocardial biopsy) and contrast imaging of the coronary arteries (coronary angiography) are still considered the most reliable methods. It is performed by pediatric cardiologists at the transplant center.
We are available to the pediatric specialists and general practitioners for any questions, especially regarding infections, vaccinations (there is a contraindication against live vaccinations) or interactions with medication prescriptions.
A heart transplant enables a good quality of life and leads to an almost normal life with attendance at kindergarten and school, as well as further vocational training.
The prognosis of the transplant is highly dependent on immunological conditions, the underlying disease leading to the transplant, the age at transplantation, any functional impairment of other organ systems and the patient's cooperation (compliance). Transplant survival has been steadily increasing over the decades and is currently at a median of 19 years, with the highest survival rate for transplants in infancy at a median of 24.5 years.
The close cooperation with the attending pediatricians and referring pediatric cardiologists as well as the high level of expertise of Austria's largest transplant center in Vienna allow supra-regional preparation of children for a heart transplant and reliable long-term follow-up care with the aim of further increasing the longevity of the new heart and enabling children to lead a long and fulfilling life.