Small hearts make big difference for young transplant recipients

When a young child is in need of a heart transplant, the problem is not the intricate surgery, but the scarcity of donors.

"Heart transplantation is a fairly straightforward procedure in children," said Dr. Charles Fraser, professor and chief of the Division of Congenital Heart Surgery at the Michael E. DeBakey Department of Surgery at Baylor College of Medicine and Chief of Congenital Heart Surgery at Texas Children's Hospital. "The big problem with pediatric heart transplantation is the scarcity donor hearts."

Donor hearts are allotted to recipients based on size and blood type compatibility, as well as the severity of a patient's illness, the urgency of the transplant and the patient's rank on a donor wait list. Although hearts that are small enough for young patients are hard to find, Fraser said small adult hearts sometimes are suitable.

According to Fraser, who performs 15 to 20 pediatric transplants a year, conditions that qualify an infant or child for a heart transplant include:

• Severe congenital heart disease, or structural anomalies of the heart that occurred during pregnancy and cannot be repaired with surgery or medication.
• Cardiomyopathy, or severe weakening of the heart muscle that hinders the heart's ability to pump blood.

"Some patients do not develop symptoms until later in life, while others present with symptoms right at birth," said Fraser. "If a donor heart is available, a transplant can technically be performed hours after a child is born."

During heart transplant surgery, the recipient's diseased heart is removed, and while a machine pumps blood through his or her body, a donor heart is sewn into place.

The length of recovery after transplant surgery varies by case, but Fraser says younger patients bounce back from surgery amazingly well.

A long-term risk of heart transplant surgery is the body rejecting the donor heart. This happens when the body's immune system recognizes the new heart as foreign and attempts to destroy it. To prevent rejection, recipients must take medications known as immunosuppressants to restrain this response. Although immunosuppressants are useful in fighting rejection, they hinder the immune system, making patients more susceptible to other illnesses. In addition to rejection, heart transplant recipients are also at risk of developing coronary artery disease.

"Patients must make a lifelong commitment to take their medications and follow up with their transplant cardiologist to minimize complications," said Fraser.

Although heart transplantation is a last resort for heart disease treatment, it is a promising option for patients.

"After surgery patients are able to do a lot of things that they were never able to do before," said Fraser. "Many, if not most, are extremely active."