Establishing a nationwide pediatric heart transplantation program with mid‐term results comparable to worldwide data – The Czech experience

Abstract

AbstractBackgroundHeart transplantation (HTx) is an established therapeutic option for children with end‐stage heart failure. Comprehensive pediatric nationwide HTx program was introduced in 2014 in the Czech Republic. The aim of this study was to evaluate its mid‐term characteristics and outcomes and to compare them with international data.MethodsRetrospective observational study, including all patients who underwent HTx from June 2014 till December 2022. Data from the institutional database were used for descriptive statistics and survival analyses.ResultsA total of 30 HTx were performed in 29 patients with congenital heart disease (CHD, N = 15, single ventricular physiology in 10 patients) and cardiomyopathy (CMP, N = 14). Ten patients were bridged to HTx by durable left ventricular assist devices (LVADs) for a mean duration of 104 (SD 89) days. There was one early and one late death during median follow‐up of 3.3 (IQR 1.3–6.1) years. Survival probability at 5 years after HTx was 93%. Two patients underwent re‐transplantation (one of them in an adult center). Significant rejection‐free survival at 1, 3, and 6 years after HTx was 76%, 63%, and 63%, respectively.ConclusionsThe introduced pediatric HTx program reflects the complexity of the treated population, with half of the patients having complex CHD and one‐third being bridged to HTx by LVADs. Mid‐term results are comparable to worldwide data. The data confirm the possibility of establishing a successful nationwide pediatric HTx program in a relatively small population country with well‐developed pediatric cardiovascular care and other transplantation programs.