Clinical outcomes of pediatric heart transplantation: A 25-year follow-up experience in a Japanese institute

Objective: Advances in medical management have markedly improved early and late outcomes after pediatric heart transplantation. Although survival data are well established in Western countries, evidence from Asia remains limited. Methods: We retrospectively reviewed the records of 75 patients who underwent heart transplantation younger than 18 years and received posttransplant care at The University of Osaka Hospital, Japan, between 2000 and 2024. Results: The cohort included 35 male patients, with a median age of 6 years at transplantation. Forty-six patients (61%) underwent transplantation in Japan and 29 (39%) underwent transplantation in other countries. Underlying diagnoses were dilated cardiomyopathy in 42 patients (56%), restrictive cardiomyopathy in 23 (31%), and congenital heart disease in 4 (5%). Overall survival was 96% at 5 and 10 years, 86% at 15 years. Major posttransplant complications included posttransplant lymphoproliferative disease (n = 9), rejection requiring intensified immunosuppression (n = 14), cardiac allograft vasculopathy (n = 5), and renal failure requiring kidney transplantation or dialysis (n = 9). Among the 38 patients who reached adulthood, 15 (39%) were employed, 14 (37%) were pursuing higher education, and 9 (24%) were neither employed nor in education. Conclusions: Pediatric heart transplantation at our institution yielded long-term survival rates comparable with international registry data. Most patients achieved stable school attendance and successful adult social reintegration.