(Montreal) Medicine emphasizes this year 35e anniversary of the first successful baby heart transplant.
Columbia University Medical Center in New York claims to be the first successful transplant on June 9, 1984. Little James Lovett was only four years old at the time of the intervention. His new heart allowed him to survive into adulthood, but with some irony, he died in his sleep when he had just begun his medical research.
The first pediatric heart transplant took place at CHU Sainte-Justine exactly one month later, on July 9, 1984. Fifteen-year-old Pierre has been waiting for a new heart for five years. Thanks to the transplant, he will become a teacher and will receive several national and international medals in running.
The Canadian press took advantage of this anniversary to discuss the situation with a cardiologist from Saint-Justin, Dr. Marie-José Raboisson.
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How has the area of pediatric heart transplantation developed over the past 35 years?
Progress has been made in immunosuppressive therapy. After a heart transplant, you must undergo a whole life course of treatment so that our body does not refuse a new heart. Initially, there was a treatment called cyclosporine, which was very effective and really changed the face of the transplantation as a whole, in particular cardiac, but there were many side effects, especially aesthetic, with hair very important, gum hypertrophy … It was a treatment that was very difficult to accept. Imagine teenage girls who had these aesthetic issues! It was not easy for them. Then came the appearance of tacrolimus, which does not have any of these side effects, with very good efficacy in terms of immunosuppression. It was a big step.
Corticosteroid use has also been significantly reduced. In the long run, we realized that it was quite harmful, especially for a heart transplant, because it contributes to damage to the coronary arteries of the transplant, atherosclerosis and the like, high blood pressure, there are several side effects …
We still cannot set up immunosuppressive treatment for each of our patients, but (we found) that after ten or fifteen years we do not need immunosuppression, as important as immediately after transplantation.
Significant progress has also been made in identifying complications – infections, treating infections – so the life expectancy of a child who has had a heart transplant is much, much longer than he is. was at that time.
How is the experience of the patient who was transplanted 35 years ago different from the experience of the patient who was transplanted today?
Hospitalization is much shorter, there are many outpatient observations, personalization of care … Currently, a child under one year old who has a heart transplant, is at least 25 years old. Life expectancy in general. If you are transplanting under the right conditions, with a child who is in good condition, well controlled, etc., we can even hope for a better survival than that.
Why does a child need a heart transplant?
Graft indication is age dependent. Usually, young children under the age of one year have a lot of cardiomyopathies, heart muscle diseases, often the heart is too big and does not compress well. We also have a slightly opposite disease, that is, the heart is too thick and it cannot provide the correct function, because it does not fill enough. After a year, we also have cardiomyopathies, but we also see the appearance of congenital cardiomyopathies, so children are born with a malformation. They are often referred to as unventricular nuclei, that is, there is only one ventricle, and over time its function decreases, the valve leaks and leads to terminal heart failure. We do 3.5 to 5.5 transfers per year in Saint Justin. We had a rather productive year: we had three transfers already this year, when we were barely at the beginning of the second half of the year.
What are your biggest problems?
The waiting time for the transplant is very, very long. At best, it is for three or four months, but we have children who have been there for more than a year on intravenous therapy with heart support in order to wait for their transplantation. There is also a size indication; you cannot accept any weight, any size for any child. Therefore, in Quebec and in Canada as a whole, it is very difficult to find plugins.
What looms on the horizon?
There are all stem cell treatments that are moving forward. There is all the research on how to get a heart or tissue from stem cells. Great progress has been made with respect to the adjustment of immunosuppressive treatment. In addition, various organizations are doing great work to promote organ donation.
What are your memories of your first transplant?
It was a little girl up to a year, blonde with beautiful green eyes, 12 years ago. I see her very regularly, this is a beautiful little teenage girl, very beautiful. Anyway, this is a bit like our children. We are very glad to see their prosperity, to adorn themselves, they have all kinds of small trusting relationships with us. They do not come to see a family member, but they still come to see someone who cares for them since they exist.
What personal relationships do you develop with your patients and their families?
(Pause) These are people about whom we already know a lot before transplanting. I really admire the children and especially their families, because it is the families who leave everything, a year of their life, two years of their life, to come to the hospital with their child, to stay with the child when he is in the hospital. I find it wonderful that these families can support for their child. They put their lives in parentheses for a year or two, often there is only one parent who works, and one who stays in the hospital to look after the child … I find this exceptional and we get attached to them a lot, And then obviously, it’s fortunate to have a compatible transplant, fortune to announce it, and then when everything is going well, it connects a lot of connections with this family. They know that we are doing everything possible to save their child, we use all the possibilities of modern medicine to save their child, so I think this gives us a very strong relationship between parents and the health team,
Dr. Rabuasson's comments have been shortened for accuracy and clarity.