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Louisville hospital ends child heart transplants

LOUISVILLE, Ky. (AP) - Kosair Children's Hospital, which
performed the nation's second successful heart transplant on an
infant 24 years ago, will no longer perform such surgeries.
The Courier-Journal reported Sunday that hospital officials said
they decided to stop performing pediatric heart transplants due to
low patient volume, but the hospital also had two infants die after
the operation last year and there was a change in the program's
leadership.
The hospital has now become "inactive" for pediatric heart
transplants in the United Network for Organ Sharing, which oversees
transplants.
"The main reason (for becoming inactive) was that it still was
a relatively low-volume program," said Dr. Mark Slaughter, a
University of Louisville professor of surgery and chief of the
division of thoracic and cardiovascular and surgery. He replaced
Dr. Robert Dowling as director of Kosair's heart-transplant program
in August.
According to UNOS, the hospital performed 44 heart transplants
on children since 1988. But even in peak years, doctors performed
only five transplants a year. Kosair's doctors performed two
transplants each in 2008 and 2009 - a small percentage of the total
307 pediatric heart transplants in 2009 and 365 in 2008.
The closest hospitals that can perform the operation are in
Indianapolis, Cincinnati and Nashville, Tenn. Kosair officials said
they would like to eventually reactivate their program.
"For the short term, it's a terrible loss to Kosair and for the
city of Louisville," said Todd Johnson of Bardstown, whose
7-year-old daughter received a new heart at Kosair when she was 1.
The 13-year-old son of Judith Popp died after a heart transplant
at Kosair in January 2008. She said she's shocked that Kosair can
no longer do the surgery.
"It's very surprising, because Kosair has such a high level of
respect for every procedure on sick children," said Popp, of Clark
County, Ind.
Popp said she doesn't blame the hospital for the death of her
son, Marquis. She said the surgery went well, but an autopsy found
that Marquis developed a fungal infection.
From 2004 to 2009, the survival rate for 12 pediatric heart
transplant patients at Kosair 67 percent, hospital officials said.
Last year's two recipients who later died were infants, who are
much more fragile than older children.
"We did our peer review.Those patients had very little chance
of survival going in to the transplants," said Tom Kmetz, Kosairs
president. "There were no system failures. They were just too sick
to make it."
Dr. William Harmon, a past member of the UNOS board who is now a
Harvard professor and doctor at Children's Hospital Boston, said
small patient volume can affect quality.
"When you're getting to the level of one or two, you have to be
concerned that the team isn't gonna be in top shape," Harmon said,
who noted that big programs do about 10 transplants a year. "If
you don't do something frequently enough, you can get into
trouble."
Kosair officials said that reactivating the transplant program
would take recruiting more doctors.
Before Kosair became inactive, three physicians performed heart
transplants and another two or three were working closely with the
heart transplant team.
Kmetz said he is now trying to attract three to five pediatric
cardiologists to Kosair and hopes to find another doctor who can do
heart transplants.
The hospital is still offering other types of transplants,
including kidney and bone-marrow transplants.
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Information from: The Courier-Journal,
http://www.courier-journal.com

(Copyright 2010 by The Associated Press. All Rights Reserved.)


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