DeBakey/Cooley Joint Session
Muhammad S. Khan, MD Jeffrey S. Heinle, MD
CME Credit Presented at the Joint Session of the Michael E. DeBakey International Surgical Society and the Denton A. Cooley Cardiovascular Surgical Society; Austin, Texas, 21–24 June 2012. Section Editor: Joseph S. Coselli, MD Key words: Heart transplan tation/statistics & numerical data; lung transplantation/ statistics & numerical data; survival analysis From: Division of Congenital Heart Surgery, Department of Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas 77030 Address for reprints: Jeffrey S. Heinle, MD, Division of Congenital Heart Surgery, Texas Children’s Hospital, 6621 Fannin St., WT 19345H, Houston, TX 77030 E-mail:
[email protected] © 2012 by the Texas Heart ® Institute, Houston
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Pediatric Thoracic Multiorgan Transplantation
T
horacic organ transplantation reached a major milestone in 2011, when the 100,000th heart-transplant recipient was registered with the International Society of Heart and Lung Transplantation (ISHLT).1 In addition, more than 38,000 lung transplants have been reported to the database. Cumulative pediatric thoracic transplantation—approximately 10,000 hearts and 1,700 lungs—constitutes less than 10% of the total number of thoracic transplantations that have been performed. The annual numbers of approximately 350 pediatric heart transplants and 70 lung transplants have remained relatively constant throughout the last decade.1 Although multiorgan transplantations are complex procedures, survival rates are similar to those of single-organ transplantation. The results of several studies have suggested a beneficial effect of transplanting multiple, simultaneous allografts, in that the incidence and severity of rejection is reduced in comparison with isolated procedures. An analysis of adult multiorgan transplantation data in the United Network of Organ Sharing (UNOS) database showed lower rejection rates for combined transplantations that involved heart, kidney, and liver allografts.2 The various immunologic and nonimmunologic mechanisms that have been linked to this protective effect include the presence and persistence of passenger donor leukocytes, the induction of suppressor T cells, immune diversion, immune paralysis, and the ability of the organs to reduce lymphocytotoxic antibodies.2 It is clear that multiple factors play a role in reducing rejection episodes and thereby improving survival rates. According to the 2011 report of the ISHLT registry,1 the overall number of thoracic multiorgan transplantations has gradually been increasing. However, the absolute number remains low in comparison with single-organ transplantations.1 This is also true in the pediatric population. Of the 2,102 thoracic multiorgan transplantations that were performed in the United States and were reported to the UNOS database through 2011, only 238 (12%) were in the pediatric population. Of these, 181 were heart–lung transplants (76%). There have also been 32 transplants of the heart and kidney (13%); 11 of the lung and liver (5%); 10 of the heart and liver (4%); 3 of the heart, lung, and liver (1%); and 1 of the lung and kidney (
