Clinical outcome of heart transplantation in children and young adults with congenital and acquired heart disease in a middle-income country: a 20-year single-center experience

Background Orthotopic heart transplantation (OHT) has become the standard of care for children with end-stage heart failure refractory to medical or conventional 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. Methods This is a retrospective study from January 2002 to December 2022. Data collection consisted of demographic data, indication, immunosuppression, main complications and mortality. Results There were 77 OHT in 74 patients. The median age at the time of OHT was 11.5 years (IQR 0.25–22 years). The indications for OHT were congenital heart disease in 36 (46.8%), cardiomyopathy in 35 (45.5%), and re-transplantation in 3 patients (primary diagnosis: 2 cardiomyopathy − 3.9%). 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 complications were: acute kidney injury (51%), systemic hypertension (41.9%), anemia (24.3%) and type 2 diabetes (10.4%). Overall survival after 1 year of OHT was 89.6% while 5- and 10-year survival, were 80% and 59%, respectively. Despite late complications, such as infection and acute rejection, all survivors report a significant improvement in functional status. Conclusion Heart transplant is an acceptable therapeutic option for children and young adults in middle-upper resourced countries, with outcomes and long term follow up close to those higher resourced countries.