Andersons pediatric cardiology 1774
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HeartandHeart-Lung
Transplantation
AnneI.Dipchand,JulieSchmidt,RichardKirk
Abstract
Outcomesforhearttransplantationforchildrenhaveimprovedremarkably
overthelast20yearsduetoimprovementsindonationandthepreservation
oforgans,selectionofpatients,postoperativemanagement,treatmentof
rejection,andmanagementofcomorbiditiesrelatedtochronic
immunosuppression.Thefieldhasevolvedfurtherwiththeavailabilityof
mechanicalsupportbridgingoptions,thoughdeathswhilewaitingremain
high.Pretransplantassessmentisofutmostimportance,asrecipientfactors
significantlyaffectwaitlisttimeandposttransplantmortalityrate.There
remaindifferencesinoutcomerelatedtodiagnosisandage,withpatients
withcardiomyopathyfaringbetterandadolescentsfaringworse.Rejection,
infection,primarygraftfailure,andcardiacallograftvasculopathyremain
themaincausesofdeath.SensitizationtoHLAantibodiesisbeingfaced
morefrequently.Acomprehensivemultidisciplinaryteamisessentialto
optimizeoutcomesbeforeandaftertransplantbymeticulousattentionto
detail.Careforchildrenafterhearttransplantationmustaccountfor
physicalgrowthanddevelopment;thestageofimmunedevelopment;
intellectual,socialandemotionalmaturation;educationalactivities;and
otherparametersofqualityoflife.Thefunctionalstatusofmostpatientsis
excellent,althoughtherearechallengeswithdevelopment,school
performance,andadherence.Futureopportunitiesincludedecreasinglongtermmorbiditiesrelatedtoimmunosuppression,improvingwaitlist
mortality,andimprovingoutcomesfortheyoungestpatientsandthosewith
congenitalheartdisease.
Keywords
Hearttransplant;Heartfailure;Rejection;Survival
ThefirsttransplantationofahumanheartwasperformedinSouthAfricain
1967.1Bytheendofthe1970s,transplantationwasestablishedasaneffective
therapyforend-stagecardiacfailure.Overthenext30years,improvementsin
donationandthepreservationoforgans,selectionofpatients,postoperative
management,andtreatmentofrejectionhaveresultedinmarkedlyimproved
survivalfollowingtransplantationinbothadultsandchildren.Consequently,
orthotopictransplantationoftheheartisnowthestandardofcareforthe
managementforsomeinfantsandchildrenwithsevereformsofcongenital
cardiacdiseaseandend-stagecardiomyopathy.Morerecently,thefieldhas
evolvedfurtherwiththeavailabilityofmechanicalsupportoptionsasabridgeto
decisionandtotransplantation,withasignificantimpactonbothwaitingand
posttransplantsurvival.
