Pediatric heart transplantation: how to manage problems affecting long-term outcomes?

Abstract

Since the initial International Society of Heart Lung Transplan tation registry was published in 1982, the number of pediatric heart transplantations has increased markedly, reach ing a steady state of 500-550 transplantation annually and occupy ing up to 10% of total heart transplantations. Heart transplan tation is considered an established therapeutic option for patients with endstage heart disease. The longterm outcomes of pediatric heart transplantations were comparable to those of adults. Issues affecting longterm outcomes include acute cellular rejection, antibodymediated rejection, cardiac allograft vasculopathy, infection, prolonged renal dysfunction, and malig nancies such as posttransplant lymphoproliferative disorder. This article focuses on medical issues before pediatric heart transplantation, according to the Korean Network of Organ Sharing registry and as well as major problems such as graft rejection and cardiac allograft vasculopathy. To reduce graft failure rate and improve longterm outcomes, meticulous monitoring for rejection and medication compliance are also important, especially in adole scents.

Characterization of Green Fluorescent Protein in Heart Valves of a Transgenic Swine Model for Partial Heart Transplant Research

“…Mechanical, homograft from cadavers, and xenografts each have individual pitfalls, but all have limited size options and do not grow with the patient resulting in high reoperation rates leading to morbidity and mortality [ 15 ]. The mortality of pediatric patients waiting for a heart transplant is high [ 17 , 18 ], and the probability of rejection or graft dysfunction increases with time [ 19 ]. Valve tissue appears to be immune-privileged to an extent, suggesting that decreased immunosuppression would be required [ 20 ].…”

My Approach to Echocardiographic Evaluation after Pediatric Heart Transplantation to Control Rejection and/or Graft Vascular Disease

“…Pediatric heart transplantation is the definitive therapeutic option for patients with heart failure refractory to optimized clinical treatment, due either to cardiomyopathies or congenital heart disease. 1,2 Since the first pediatric heart transplant by Dr. Adrian Kantrowitz in 1967 to the present day, when approximately 700 transplants per year are performed, there has been substantial progress in the study of the immune response to grafts, the use of medications, surgical techniques, and lifestyle changes. Therefore, survival after pediatric transplantation has progressively improved in recent years, with a median survival of 18 years DOI: https://doi.org/10.36660/abcimg.20230045i for all age groups; for transplants performed in patients younger than 1 year of age, the median survival is greater than 24 years.…”

“…Siqueira & Andrade Evaluation after pediatric heart transplantation injury, adaptation of the right ventricle to elevated pulmonary artery pressure, and the presence of circulating inflammatory mediators. 2,3 The use of immunosuppressants, mainly cyclosporine, 6 increased circulating catecholamines, systemic arterial hypertension, and worsening lymphatic drainage lead to a progressive increase in ventricular mass, which peaks around the third postoperative month and progressively reduces until normalization in the first year after transplantation 5 (Figure 1).…”

The Waiting List Mortality of Pediatric Heart Transplantation Candidates in Korea before the Pediatric Ventricular Assist Device Era

“… 5 6 In Korea, the first successful pediatric heart transplantation was performed in 1997, and 10–15 cases are added annually according to the Korean Network of Organ Sharing (KONOS). 7 Recently, the use of a VAD has been available for pediatric patients, so a much better outcome can be expected in pediatric heart transplantation in Korea. However, no national studies about the waiting list mortality of pediatric heart transplantation patients before the use of VAD in Korea have been conducted; therefore, we collected and analyzed the data from most of the centers.…”