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Updated: Aug 25, 2026
An Immunological Model for Heterotopic Heart and Cardiac Muscle Cell Transplantation in Rats
Published on: May 8, 2020
[Cardiac retransplantation in childhood. Questions and answers]
F Iserin1, J Le Bidois, D Tamisier
1Service de cardiologie pédiatrique, hôpital Necker-Enfants malades, Paris 75015. franck.iserin@nck.ap-hop-paris.fr
Insights
Pediatric heart retransplantation is a viable option for children with severe coronary artery disease in their transplanted heart. Good survival and morbidity outcomes support retransplantation, even with renal failure or allo-immunisation.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Transplantation Medicine
Context:
- Pediatric cardiac transplantation is a palliative measure, with many recipients likely needing retransplantation.
- Coronary artery disease (CAD) is the primary reason for re-transplantation in this population.
- Previous transplant outcomes and current patient status influence re-transplantation decisions.
Purpose:
- To evaluate the outcomes and indications for pediatric cardiac retransplantation.
- To assess the role of retransplantation in managing severe coronary artery disease in pediatric heart recipients.
- To determine if renal failure and allo-immunisation are contraindications for retransplantation.
Summary:
- Cardiac retransplantation in children, particularly for severe coronary artery disease, demonstrates encouraging survival and morbidity rates.
- Retransplantation is justified for severe transplant-related coronary artery disease, with renal failure and allo-immunisation not being absolute contraindications.
- Coronary revascularization may serve as a bridge to retransplantation when indicated.
Impact:
- Supports the use of retransplantation as a life-extending therapy for pediatric heart transplant recipients with advanced coronary artery disease.
- Highlights the importance of considering retransplantation despite comorbidities like renal failure or allo-immunisation.
- Emphasizes the need for ongoing research into preventing and treating transplant-related coronary artery disease.
Abstract:
Cardiac transplantation in childhood remains a long-term palliative procedure and it is probable that an increasing number of patients undergoing this procedure in childhood will require a new transplant one day. Coronary artery disease of the transplanted heart is the main indication. The results (in terms of survival and morbidity) in the literature and in the authors' experience are encouraging and justify the indication for retransplantation in cases of severe coronary disease of the transplanted heart. The indication is not as clear-cut in transplantation performed early or as an emergency for primary graft dysfunction, which carries a high mortality. Renal failure and allo-immunisation are not contra-indications to this procedure. Occasionally, procedures of coronary revascularisation provide time to wait for a new transplant. In the absence of more effective preventive or curative treatment of coronary disease of the transplant, the good results of retransplantation justify the procedure for this indication and reinscription on the waiting list for cardiac transplantation.
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