Immunology of pediatric heart transplantation: a clinical update

In the last decade, tremendous advances in our understanding of immune responses to solid organ allografts have been realized. These advances are now resulting in improved management of patients. It is hoped that these advances may soon lead to successful tolerance induction, relieving the patient of the lifetime burden of immunosuppressive therapy. The molecular and cellular mechanisms involved in acute and chronic allograft rejection are reviewed in detail elsewhere in this annual. This review will focus on the immunologic aspects of clinical heart transplantation, with emphasis on recent advances in knowledge in the pediatric population. Risk factors for detection, prevention, and treatment of acute and chronic rejection are discussed. The immunologic burden of nonspecific immunosuppression (infection, post-transplant lymphoproliferative disorders, and malignancy) is reviewed. The prospects for achievement of donor-specific tolerance in the clinic are discussed.